SGLT2 inhibitors: Do they have antiarrhythmic properties?
Ricardo Caballero1, Juan Tamargo1, Eva Delpón1
1Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, 28040 Madrid, Spain.
Pharmacology & Therapeutics
|January 7, 2026
Summary
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) show promise in reducing atrial fibrillation in patients with heart failure or kidney disease. Further research is needed to confirm their effects on ventricular arrhythmias and sudden cardiac arrest.
Area of Science:
- Cardiology
- Pharmacology
- Nephrology
Background:
- Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are vital for managing type 2 diabetes, heart failure, and chronic kidney disease.
- Patients with these conditions face an elevated risk of cardiac arrhythmias, especially with coexisting comorbidities.
Purpose of the Study:
- To review experimental and clinical evidence on the antiarrhythmic effects of SGLT2 inhibitors.
- To explore potential mechanisms, limitations, and knowledge gaps regarding SGLT2i in arrhythmia prevention and treatment.
Main Methods:
- Narrative review of existing literature.
- Analysis of experimental models and clinical trials, including meta-analyses.
- Examination of direct cardiac and indirect extracardiac effects.
Main Results:
- SGLT2i demonstrate antiarrhythmic effects in experimental models.
- Clinical evidence suggests SGLT2i reduce new-onset and recurrent atrial fibrillation in heart failure and CKD patients, irrespective of diabetes status.
- Evidence for reducing ventricular arrhythmias and sudden cardiac arrest is currently weak and requires confirmation.
Conclusions:
- SGLT2i may offer antiarrhythmic benefits through direct cardiac and indirect extracardiac mechanisms, including improved electrical, structural, and autonomic remodeling.
- Current clinical evidence is largely hypothesis-generating, particularly for ventricular arrhythmias.
- Further research is essential to validate these findings and establish SGLT2i's role in arrhythmia management.
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