Clinical Electrophysiology -> Atrial Fibrillation & Atrial Flutter: -> Pharmacology (Antiarrhythmic drugs and anticoagulants)
D-PO02 - Poster Session II (ID 47)
Poster
D-PO02-222 - SGLT2 Inhibitors Reduce The Risk Of Arrhythmias And Sudden Cardiac Death In Diabetes Or Heart Failure: A 59,151-patient Meta-analysis Of Randomized Controlled Trials (ID 262)
Abstract
Background: Randomized studies show that sodium-glucose cotransporter 2 inhibitors (SGLT2i) reduce heart failure (HF) death and hospitalizations, but its effect on arrhythmias have not been investigated.
Objective: Meta-analysis of arrhythmia endpoints in randomized trials of SGLT2i use in patients with diabetes or HF.
Methods: Pubmed and ClinicalTrials.gov were searched. Outcomes were ventricular arrhythmias (VA) - VT/VF, incident atrial arrhythmias (AA) - fibrillation or flutter, and sudden cardiac death (SCD). Subgroup analysis was performed based on the SGLT2i used.
Results: We included 29 randomized (25 placebo-controlled and 4 active-controlled) trials with 59,151 patients (33,322 SGLT2i vs 25,829 control - mean age 53-67 yrs, 43-76% male), using canagliflozin, dapagliflozin, empagliflozin or ertugliflozin. Except for one study, all patients had type 2 diabetes, diagnosed for 5.5 to 15.8 years. Follow-up ranged from 24 weeks to 3.6 years. Annual event rates were low - 1.1%, 0.4% and 0.6% for AA, VA and SCD, respectively. SGLT2i therapy was associated with a significant reduction in risk of incident AA (OR 0.82 [0.70-0.96], p=0.01, Fig) and of SCD (OR 0.7 [0.50-0.97], p=0.03) compared with control. The difference in risk of VA between groups (OR 0.84 [0.63-1.12], p=0.23) was not statistically significant. On subgroup analysis, dapagliflozin was the only SGLT2i associated with significantly reduced risk of AA.
Conclusion: SGLT2i are associated with significantly reduced risk of incident AA and SCD in patients with diabetes or HF. Prospective trials are warranted to confirm the antiarrhythmic effect of SGLT2i and whether this is a class or drug-specific effect.
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Objective: Meta-analysis of arrhythmia endpoints in randomized trials of SGLT2i use in patients with diabetes or HF.
Methods: Pubmed and ClinicalTrials.gov were searched. Outcomes were ventricular arrhythmias (VA) - VT/VF, incident atrial arrhythmias (AA) - fibrillation or flutter, and sudden cardiac death (SCD). Subgroup analysis was performed based on the SGLT2i used.
Results: We included 29 randomized (25 placebo-controlled and 4 active-controlled) trials with 59,151 patients (33,322 SGLT2i vs 25,829 control - mean age 53-67 yrs, 43-76% male), using canagliflozin, dapagliflozin, empagliflozin or ertugliflozin. Except for one study, all patients had type 2 diabetes, diagnosed for 5.5 to 15.8 years. Follow-up ranged from 24 weeks to 3.6 years. Annual event rates were low - 1.1%, 0.4% and 0.6% for AA, VA and SCD, respectively. SGLT2i therapy was associated with a significant reduction in risk of incident AA (OR 0.82 [0.70-0.96], p=0.01, Fig) and of SCD (OR 0.7 [0.50-0.97], p=0.03) compared with control. The difference in risk of VA between groups (OR 0.84 [0.63-1.12], p=0.23) was not statistically significant. On subgroup analysis, dapagliflozin was the only SGLT2i associated with significantly reduced risk of AA.
Conclusion: SGLT2i are associated with significantly reduced risk of incident AA and SCD in patients with diabetes or HF. Prospective trials are warranted to confirm the antiarrhythmic effect of SGLT2i and whether this is a class or drug-specific effect.
