We aimed to assess the effect of SGLT2i on arrhythmias by conducting a meta-analysis using data from randomized controlled trials(RCTs). Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have shown cardioprotective effects via multiple mechanisms that may also contribute to decrease arrhythmias risk. We searched in databases (PubMed, Embase, Cochrane Library, and clinicaltrials.gov) up to April 2023. RCTs comparing SGLT2i with placebo were included. The effects of SGLT2i on atrial fibrillation(AF), atrial flutter(AFL), composite AF/AFL, ventricular fibrillation(VF), ventricular tachycardia(VT), ventricular extrasystoles(VES), sudden cardiac death(SCD) and composite VF/VT/SCD were evaluated. 33 placebo-controlled RCTs were included, comprising 88,098 patients (48,585 in SGLT2i vs. 39,513 in placebo). The mean age was 64.9 ± 9.4 years, 63.0% were male. The mean follow-up was 1.4 ± 1.1 years. The pooled-results showed that SGLT2i was associated with a significantly lower risk of AF [risk ratio(RR): 0.88, 95% confidence interval(CI) 0.78–1.00, P = 0.04] and composite AF/AFL (RR: 0.86, 95%CI 0.77–0.96, P = 0.01). This favorable effect appeared to be substantially pronounced in patients with HFrEF, male gender, dapagliflozin, and > 1 year follow-up. For SCD, only in heart failure patients, SGLT2i were found to be associated with a borderline lower risk of SCD (RR: 0.67, P = 0.05). No significant effects of SGLT2i on other ventricular arrhythmic outcomes were found. SGLT2i lowers the risks of AF and AF/AFL, and this favorable effect appeared to be particularly pronounced in patients with HFrEF, male gender, dapagliflozin, and longer follow-up (> 1 year). SGLT2i lowers the risk of SCD only in heart failure patients.

中文翻译：

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SGLT-2 抑制剂对心律失常事件的影响：来自超过 80,000 名患者的更新二次分析的见解（SGLT2i — 心律失常和心源性猝死）

我们的目的是通过使用随机对照试验 (RCT) 的数据进行荟萃分析来评估 SGLT2i 对心律失常的影响。钠-葡萄糖协同转运蛋白 2 抑制剂 (SGLT2i) 通过多种机制显示出心脏保护作用，也可能有助于降低心律失常风险。我们检索了截至 2023 年 4 月的数据库（PubMed、Embase、Cochrane Library 和 ClinicalTrials.gov）。其中包括比较 SGLT2i 与安慰剂的随机对照试验。SGLT2i对心房颤动(AF)、心房扑动(AFL)、复合AF/AFL、心室颤动(VF)、室性心动过速(VT)、室性早搏(VES)、心源性猝死(SCD)和复合VF/评估VT/SCD。纳入了 33 项安慰剂对照随机对照试验，包括 88,098 名患者（SGLT2i 组为 48,585 名患者，安慰剂组为 39,513 名患者）。平均年龄为 64.9 ± 9.4 岁，其中 63.0% 为男性。平均随访时间为 1.4 ± 1.1 年。汇总结果显示，SGLT2i 与 AF 风险显着降低相关 [风险比 (RR)：0.88，95% 置信区间 (CI) 0.78–1.00，P = 0.04] 和复合 AF/AFL（RR：0.86， 95%CI 0.77–0.96，P = 0.01）。这种有利的效果在 HFrEF、男性、达格列净且随访超过 1 年的患者中似乎非常明显。对于 SCD，仅在心力衰竭患者中，SGLT2i 被发现与临界较低的 SCD 风险相关（RR：0.67，P = 0.05）。未发现 SGLT2i 对其他室性心律失常结果有显着影响。SGLT2i 降低了 AF 和 AF/AFL 的风险，这种有利的效果似乎在 HFrEF、男性、达格列净和较长随访时间（> 1 年）的患者中尤其明显。SGLT2i 仅降低心力衰竭患者发生 SCD 的风险。