In a study published in Cardiovascular Diabetology, Hang-Long et al searched the MEDLINE, EMBASE, and databases from inception to August 27, 2020. Randomized, controlled trials that randomized patients with diabetes mellitus (DM), chronic kidney disease (CKD), or heart failure (HF) to SGLT2i or placebo were included. The outcomes of interest include atrial fibrillation (AF), embolic stroke, atrial flutter (AFL), AF/AFL, ventricular tachycardia (VT), and cardiac arrest. Relative risks (RRs) and 95% confidence intervals (CI) were pooled using a random-effects model.

The researchers found that the overall percentage of participants included with DM was 94.6%, 53.0% with CKD, and 21.4% with HF, and the average percentage with a history of AF was 10.2% (range 5.5-70.9). Eleven trials had a low risk for bias, six trials had a high risk for bias, and five trials had an unclear risk for bias. The researchers found that SGLT2i treatment was correlated with an 18% lower risk for AF (RR, 0.82; 95% CI, 0.70-0.96; P = .94), and a 68% lower risk for embolic stroke (RR, 0.32; 95% CI, 0.12-0.85; P = .99), compared with placebo.

With AF and AFL used as a composite endpoint, SGLT2i were linked with an 18% decline in risk compared with placebo (RR, 0.82; 95% CI, 0.71-0.95; P =.90). Compared with placebo, SGLT2i use was associated with a 27% reduction in VT risk (RR 0.73; 95% CI, 0.53-0.99; P =.61), while the AFL and cardiac-arrest risk decreases did not reach statistical significance (RR 0.83; 95% CI, 0.68-1.17; and RR, 0.83; 95% CI, 0.61-1.14; respectively). These correlations seemed to remain stable across varying baseline conditions (atherosclerotic cardiovascular disease [ASCVD] vs. no ASCVD; DM vs. CKD vs. HF), follow-up duration, and the SGLT2i utilized.

The researchers concluded that SGLT2i diminished the risk of AF and VT. The authors also noted that the results from this study provide further robust evidence for recommending the utilization of SGLT2i in patients with DM, CKD, and HF to decrease related cardiac complications and comorbidities. However, the mechanisms by which SGLT2i protects against arrhythmias are intricate and further research is warranted.

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