SGLT2 inhibitors may reduce new-onset and recurrences of atrial fibrillation in patients with heart failure or chronic kidney disease, but evidence for ventricular arrhythmias is weak.
Do SGLT2 inhibitors have antiarrhythmic properties in patients with T2D, HF, or CKD?
SGLT2 inhibitors appear to reduce atrial fibrillation risk in HF or CKD patients, though evidence for ventricular arrhythmias remains weak and hypothesis-generating.
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) represent the cornerstone of therapy in patients with type 2 diabetes (T2D), heart failure (HF), or chronic kidney disease. These patients present a high risk of cardiac arrhythmias, particularly when these comorbidities coexist. In experimental models SGLT2i exert antiarrhythmic effects and clinical studies and meta-analyses strongly suggest that they reduce new-onset and recurrences of atrial fibrillation in patients with HF or CKD irrespective of the diabetic status. Although some trials and meta-analyses suggest that SGLT2i could decrease the risk of ventricular arrhythmias and sudden cardiac arrest, the evidence is weak, and their potential remains to be confirmed. Thus, clinical evidence so far should be considered as hypothesis-generating. Although the exact mechanism underlying their antiarrhythmic effects remains uncertain and much research is needed, multiple direct cardiac and extracardiac effects may be involved. They improve cardiac electrical (via changes in ion channels and transporters; maintenance of Na
Caballero et al. (2026) studied this question. SGLT2 inhibitors may reduce new-onset and recurrences of atrial fibrillation in patients with heart failure or chronic kidney disease, but evidence for ventricular arrhythmias is weak.