Sodium-glucose co-transporter-2 inhibitors and the risk of major arrhythmias: a meta-analysis of the cardiovascular and renal outcome trials

Abstract Background Type 2 diabetes mellitus is closely associated with cardiovascular disease and evidence already exists on its arrhythmogenic action. Sodium-glucose cotransporter inhibitors (SGLT2i) are a unique class of oral antidiabetic medications which recently attracted attention for reducing the total risk major adverse events in series recent, large placebo-controlled randomized clinical trials (RCTs). Dapagliflozin empagliflozin additionally seem to improve survival outcomes patients heart failure reduced ejection fraction (HFrEF), irrespective presence mellitus. Whether treatment sodium-glucose co-transporter could reduce arrhythmic burden diabetic still be clarified. Purpose The purpose present meta-analysis was report impact SGLT2i several types cardiac arrhythmias, pooling data from all relevant renal outcome, placebo-controlled, RCTs, comparing placebo. Methods We searched PubMed available outcome RCTs utilizing SGLT2i, along grey literature sources. sought determine following arrhythmias/cardiac disorders use versus placebo: atrial fibrillation, flutter, supraventricular tachycardia, ventricular extrasystoles, sinus bradycardia, node dysfunction, second degree atrioventricular block, complete block. Results extracted 8 (5 dedicated trials, 1 trial enrolling HFrEF), 55,966 patients. SGLT-2i compared placebo produced significant reduction fibrillation equal 21% (RR=0.79, 95% CI: 0.67–0.93, I2=0%) (Figure 1). A non-significant flutter 9% (RR=0.91, 0.64–1.29, also observed 2). No effect rest arrhythmias observed. Conclusions Antidiabetic therapy seems hold antiarrhythmic type mellitus, development. FUNDunding Acknowledgement funding sources: None. Figure