Table 1 Summary of study results on the association between SGLT2 inhibitors (SGLT2i) and atrial arrhythmias
From: SGLT2 inhibitors and the cardiac rhythm: unraveling the connections
Study name | SGLT2i | Year | Number of patients | Inclusion criteria | Findings |
|---|---|---|---|---|---|
Fatima et al. [60] | Multiple (Meta analysis) | 2023 | 111,773 | All RCTs that evaluated SGLT2is against placebo or another medication | Decrease in AF episodes when SGLT2is are administered as a standalone treatment, with a more pronounced effect in T2DM patients |
Li HL et al. [61] | Multiple (Meta analysis) | 2021 | 52,115 | RCTs involving patients with T2DM, chronic kidney disease (CKD), or HF comparing SGLT2i to a placebo | SGLT2is were linked to a reduced risk of AF, AF/AFL and embolic stroke |
Li Daobo et al. [62] | Multiple (Meta analysis) | 2021 | 66,685 | RCTs that compare SGLT2i against a corresponding placebo and report on AF/AFL results | Only dapagliflozin showed a significant decrease in AF/AFL, while other SGLT2is did not |
Li Wen Jie et al. [63] | Multiple (Meta analysis) | 2022 | 85,701 | RCTs that assesses SGLT2is against GLP-1 receptor agonists (GLP-1RAs), or compare either to placebo in patients with T2DM | Relative to a placebo, both SGLT2is and GLP-1RAs decreased the likelihood of AF/AFL. Among the SGLT2is, only dapagliflozin showed a significant reduction in AF/AFL |
Ong et al. [64] | Multiple (Meta analysis) | 2022 | 35,702 | RCTs with a placebo control that examine the results of stroke and/or AF in patients receiving SGLT2is | Patients taking SGLT2is showed a reduced likelihood of AF relative to those on placebo. This significant association persisted in studies that had a follow-up period exceeding 1Â year, particularly in those that used dapagliflozin |
Pandey et al. [65] | Multiple (Meta analysis) | 2021 | 75,279 | RCTs assessing SGLT2is or dual SGLT1/2 inhibitors | Reduction in total AF events with SGLT inhibitors |
Zheng et al. [66] | Multiple (Meta analysis) | 2022 | 63,604 | Patients who were exposed to SGLT2is and had their AF risks documented were included | Treatment with SGLT2is was linked to a significant decrease (18%) in the likelihood of new-onset AF compared to the control; the effect was most pronounced with dapagliflozin |
Fernandes et al. [67] | Multiple (Meta analysis) | 2021 | 63,166 | Randomized and double-blind design; SGLT2i and presence of a control group with diagnosed T2DM, HF, or both; and mandated follow-up of 24Â weeks | Therapy using SGLT2i was linked to a notable decrease in the likelihood of developing atrial arrhythmias |
Liao et al. [68] | Multiple (Meta analysis) | 2022 | 33,124 SGLT2is and 26,568 controls | RCTs that contrast any of the SGLT2is, GLP1RAs, or DPP4is against a placebo | Compared to placebos, SGLT2is were linked to reduced incidences of AF and bradycardia events |
Chen et al. [69] | Empagliflozin and dapagliflozin | 2020 | 79,150 SGLT2is and 79,150 controls | Patients above 20Â years of age taking SGLT2is and diagnosed with T2DM | The group treated with SGLT2is had a reduced likelihood of all-cause death and the development of new arrhythmias |
Zelniker et al. [56] | Dapagliflozin (DECLARE-TIMI 58) | 2020 | 17,160 | Patients taking SGLT2is with T2DM and ASCVD risk factors or known ASCVD | Dapagliflozin decreased the likelihood of AF/AFL occurrences by 19% |
Sfairopoulous et al. [70] | Multiple (Meta analysis) | 2023 | 9467 | Adult patients with HFrEF which compared SGLT2i with placebo arm | Reduction in AF risk; AF/AFL reduction. Empagliflozin was found to have a significant association |
Yin et al. [71] | Multiple (Meta analysis) | 2022 | 10,344 | RCTs with HF with SGLT2i vs. placebo arm. AF, AF/AFL outcomes of interest | SGLT2i reduced the incidence of AF by 37% and AF/AFL by 34 |