SGLT2 inhibitors and the cardiac rhythm: unraveling the connections

Sodium-glucose co-transporter 2 inhibitors (SGLT2is), primarily used for managing type 2 diabetes mellitus, have recently gained attention for their potential cardiovascular benefits. This review explores the emerging evidence surrounding the association between SGLT2is and arrhythmias. Initial studies and large cardiovascular outcome trials have indicated that SGLT2is may reduce major adverse cardiovascular events, including HFHs, which inherently suggests a potential anti-arrhythmic role. Mechanistic insights propose that SGLT2is may exert their anti-arrhythmic effects by modulating cardiac ion channels, thereby impacting cardiac action potentials. Direct clinical evidence linking SGLT2 is to reduced arrhythmias remains limited but evolving. Potential implications of these findings could revolutionize treatment approaches, expanding the indications for SGLT2is prescriptions beyond the diabetic population and possibly providing a novel therapeutic avenue for patients at risk of arrhythmias. However, the exact mechanism, efficacy, and safety profile need further investigation. While various post-hoc and meta-analyses shed light on the topic, prospective, randomized controlled trials are warranted to explicate the potential of SGLT2is in arrhythmia management, their place in clinical guidelines, and their overall impact on patient outcomes.