Why the study?
SGLT2 inhibitors are essential in guideline-directed medical therapy for heart failure, but their role in arrhythmia prevention remains uncertain.
Do SGLT2 inhibitors reduce the risk of arrhythmias and sudden cardiac death in patients with heart failure?
Do SGLT2 inhibitors reduce the risk of arrhythmias and sudden cardiac death in patients with heart failure?
SGLT2 inhibitors significantly reduce the risk of sudden cardiac death and atrial arrhythmias in patients with HFrEF, highlighting potential anti-arrhythmic benefits in this subgroup.
Answers are grounded in this paper and cite their sources.
SGLT2i should not be prescribed for arrhythmia prevention in HF; challenges broad antiarrhythmic hypotheses while leaving SCD-specific benefits open.
Background/Objectives: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have revolutionized heart failure (HF) therapies and are an essential component of guideline-directed medical therapy (GDMT); however, their significance in arrhythmia prevention is still uncertain. This meta-analysis evaluates the benefits of SGLT2i on arrhythmias in HF. Methods: A comprehensive examination was performed with PubMed, ScienceDirect, PLOS One, Cochrane, Google Scholar, and ClinicalTrials.gov from January 2014 to March 2025, complying with PRISMA guidelines. Randomized controlled trials (RCTs) comparing SGLT2i with placebo were incorporated. Primary results included ventricular arrhythmias (VA), sudden cardiac death (SCD), atrial arrhythmias, and conduction disorders. Subgroup analyses investigated the effects on arrhythmias in HF with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). Results: A total of 11 RCTs involving 23,701 patients, 11,848 on SGLT2i (mean age: 68.26 ± 10 yrs, 53.5% males) and 11,853 on placebo (mean age: 67.91 ± 10 yrs, 53% males), were analyzed with a mean follow-up of 2.71 yrs. No significant differences were reported between SGLT2i and placebo for VA [relative risk (RR): 1.02, 95% confidence interval (CI): 0.83–1.25], I2 =0%), atrial arrhythmias (RR: 0.92 [CI: 0.67–1.27], I2 = 65.3%), or conduction disorders (RR:1.22 [CI: 0.86–1.73], I2 = 10.4%). Notably, significant reductions in risk of SCD (RR: 0.68 [CI: 0.49–0.93], I2 = 0%) and in the risk of atrial arrhythmias in HFrEF (RR: 0.66 [CI: 0.49–0.89], I2 = 10.3%) were witnessed, although no such reduction was seen in HFpEF (RR: 1.14 [CI: 0.94–1.40], I2 = 33.8%). Conclusions: SGLT2i do not reduce overall arrhythmia or conduction disorder risk in HF but significantly reduce the risk of SCD and atrial arrhythmias in HFrEF patients. These results highlight potential arrhythmia prevention benefits in HFrEF, warranting further targeted studies.
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Suresh et al. (2025) studied this question.
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