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Effect of SGLT-2 inhibitors on arrhythmia events: insight from an updated secondary analysis of > 80,000 patients (the SGLT2i-Arrhythmias and Sudden Cardiac Death).

Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China. Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Heart Clinic Pratteln, Zentrum Für Kardiologie, Pratteln, Switzerland. Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China. lingzhiyu@cqmu.edu.cn. Department of Cardiology, Angiology, Intensive Care, cNEP, Cardiac Neuro- & Electrophysiology Research Consortium, EVK Düsseldorf, Düsseldorf, Germany. DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany. Institute of Neural and Sensory Physiology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany. Department for Internal Medicine 2 - Cardiology, Angiology, and Intensive Care, Akademisches Lehrkrankenhaus, Ordensklinikum Linz Elisabethinen, Linz, Austria. Klinik Für Elektrophysiologie/Rhythmologie, Herz- Und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik Der Ruhr-Universität Bochum, Bad Oeynhausen, Germany. St. Joseph's Heart Rhythm Center, Medical College, University of Rzeszów, Rzeszów, Poland. University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland. Abteilung Für Kardiologie, Klinik Floridsdorf Wien, Vienna, Austria. Department of Cardiology, AZ Delta, Roeselare, Belgium. Kardiologie, Frankfurt Rotkreuz Kliniken, Frankfurt am Main, Germany. School of Medicine-Royal Perth Hospital Unit, University of Western Australia, Perth, Australia. Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China. drsjchen@126.com. Department for Internal Medicine 2 - Cardiology, Angiology, and Intensive Care, Akademisches Lehrkrankenhaus, Ordensklinikum Linz Elisabethinen, Linz, Austria. drsjchen@126.com. Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany. drsjchen@126.com.

Cardiovascular diabetology. 2024;(1):78
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Abstract

OBJECTIVE We aimed to assess the effect of SGLT2i on arrhythmias by conducting a meta-analysis using data from randomized controlled trials(RCTs). BACKGROUND Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have shown cardioprotective effects via multiple mechanisms that may also contribute to decrease arrhythmias risk. METHODS We searched in databases (PubMed, Embase, Cochrane Library, and clinicaltrials.gov) up to April 2023. RCTs comparing SGLT2i with placebo were included. The effects of SGLT2i on atrial fibrillation(AF), atrial flutter(AFL), composite AF/AFL, ventricular fibrillation(VF), ventricular tachycardia(VT), ventricular extrasystoles(VES), sudden cardiac death(SCD) and composite VF/VT/SCD were evaluated. RESULTS 33 placebo-controlled RCTs were included, comprising 88,098 patients (48,585 in SGLT2i vs. 39,513 in placebo). The mean age was 64.9 ± 9.4 years, 63.0% were male. The mean follow-up was 1.4 ± 1.1 years. The pooled-results showed that SGLT2i was associated with a significantly lower risk of AF [risk ratio(RR): 0.88, 95% confidence interval(CI) 0.78-1.00, P = 0.04] and composite AF/AFL (RR: 0.86, 95%CI 0.77-0.96, P = 0.01). This favorable effect appeared to be substantially pronounced in patients with HFrEF, male gender, dapagliflozin, and > 1 year follow-up. For SCD, only in heart failure patients, SGLT2i were found to be associated with a borderline lower risk of SCD (RR: 0.67, P = 0.05). No significant effects of SGLT2i on other ventricular arrhythmic outcomes were found. CONCLUSIONS SGLT2i lowers the risks of AF and AF/AFL, and this favorable effect appeared to be particularly pronounced in patients with HFrEF, male gender, dapagliflozin, and longer follow-up (> 1 year). SGLT2i lowers the risk of SCD only in heart failure patients.

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Publication Type : Meta-Analysis

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