What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Adults (≥18 years) with implantable cardioverter-defibrillators (ICDs) and heart failure or at risk for ventricular arrhythmias (n=1605). Intervention: SGLT2 inhibitors vs. Placebo or usual care. Primary outcome: Total ventricular arrhythmia, ventricular tachycardia, and supraventricular tachycardia (RR 0.38, 95% CI 0.17 to 0.81, p=0.01).

What question did this study set out to answer?

The study aims to evaluate the effect of SGLT2 inhibitors on ventricular arrhythmias among patients with implantable cardioverter-defibrillators (ICDs).

March 2, 2026Open Access

The impact of sodium glucose cotransporter-2 inhibitors on ventricular arrhythmia in patients with implantable cardioverter-defibrillators: a meta analysis

Key Result

SGLT2 inhibitors reduced total ventricular arrhythmia risk by 62% (RR 0.38) compared to placebo in adults with ICDs.

Key Points

The study aims to evaluate the effect of SGLT2 inhibitors on ventricular arrhythmias among patients with implantable cardioverter-defibrillators (ICDs).
Conducted a meta-analysis on available studies about SGLT2 inhibitors in ICD patients.
Analyzed the occurrence of ventricular arrhythmias and ICD shocks during therapy.
Assessed secondary outcomes including cardiovascular mortality.
SGLT2 inhibitor therapy significantly reduced ventricular arrhythmias in ICD patients.
Discreet sustained ventricular tachycardia (VT) occurrences declined.
Fewer ICD shocks reported in patients receiving SGLT2 inhibitors.

Study Design

Type

Meta-Analysis (n=1,605)

Multicenter

Yes

Structured PICO

Does SGLT2 inhibitor therapy reduce ventricular arrhythmias in patients with implantable cardioverter-defibrillators?

Population

1,605 adults (≥ 18 years) with an implantable cardioverter-defibrillator (ICD) pooled from 6 studies (3 RCTs, 3 observational). Mean age ranged from 54.2 to 70.2 years, 58.6% male. Multinational (Iran, Turkey, Japan, Germany, Italy, Austria).

Intervention

Sodium-glucose cotransporter-2 (SGLT2) inhibitors as a class (including empagliflozin, dapagliflozin, and ertugliflozin)

Comparator

Placebo or usual care/control group

Outcome

Total ventricular arrhythmia, ventricular tachycardia, and supraventricular tachycardiahard clinical

In patients with implantable cardioverter-defibrillators, SGLT2 inhibitor therapy significantly reduces the burden of ventricular arrhythmias, supraventricular tachycardia, ICD shocks, and cardiovascular mortality.

Main Result

Effect estimate: RR 0.38 (95% CI 0.17 to 0.81)

Absolute Event Rate: 12.3% vs 34.4%

p-value: p=0.01

Limitations

Heterogeneity in study designs, eligibility criteria, baseline risk, and endpoint definitions.
Inclusion of both RCTs and observational studies increases risk of bias due to confounding.
Single large observational study contributed over half of patients, possibly introducing weighting bias.
Relatively short follow-up durations may underestimate long-term benefits.
Lack of individual patient-level data prevented adjustment for covariates and time-to-event analyses.
Variability in device programming across studies may have affected incidence of therapies.
Insufficient data to perform RCT-only sub-analysis for higher rigor.

Abstract

In ICD patients, SGLT2 inhibitor therapy significantly reduced ventricular arrhythmias, discrete sustained VT, and SVT, with secondary analyses suggesting fewer ICD shocks and reduction in CV mortality in the patients with ICD.

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