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SGLT2 Inhibitors and the Risk of Arrhythmias in Heart Failure: A Network Meta-Analysis
Suchith Boodgere Suresh1, Aishwarya Prasad1, Muhammad Furqan Ubaid1
1Internal Medicine, Montefiore St Luke's Cornwall, Newburgh, NY 12550, USA.
Journal of Clinical Medicine
|August 14, 2025
Summary
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) do not reduce overall arrhythmia risk in heart failure (HF). However, SGLT2i significantly lower the risk of sudden cardiac death and atrial arrhythmias in patients with heart failure with reduced ejection fraction (HFrEF).
Area of Science:
- Cardiology
- Pharmacology
Background:
- Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are established heart failure (HF) therapies.
- Their impact on arrhythmia prevention in HF remains unclear.
- This meta-analysis investigates SGLT2i's role in arrhythmia risk reduction.
Purpose of the Study:
- To evaluate the efficacy of SGLT2 inhibitors in preventing arrhythmias in heart failure patients.
- To analyze effects on ventricular arrhythmias, atrial arrhythmias, sudden cardiac death, and conduction disorders.
- To conduct subgroup analyses for HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF).
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, ScienceDirect, etc.) from January 2014 to March 2025.
- Included randomized controlled trials (RCTs) comparing SGLT2i with placebo in HF patients.
- Analyzed primary outcomes including ventricular arrhythmias (VA), sudden cardiac death (SCD), atrial arrhythmias, and conduction disorders.
Main Results:
- Eleven RCTs with 23,701 patients were analyzed.
- No significant difference in overall VA, atrial arrhythmias, or conduction disorders between SGLT2i and placebo.
- Significant reduction in SCD risk (RR: 0.68) and atrial arrhythmias in HFrEF (RR: 0.66) observed.
Conclusions:
- SGLT2i do not offer broad protection against arrhythmias or conduction disorders in the general HF population.
- SGLT2i demonstrate significant benefits in reducing SCD and atrial arrhythmias specifically within the HFrEF subgroup.
- Further research is warranted to explore these targeted arrhythmia prevention benefits in HFrEF.
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