Heart Failure -> Heart Failure Management: -> Pharmacology D-PO06 - Poster Session VI (ID 26) Poster

D-PO06-076 - Arrhythmia Outcomes In Patients Treated With Sodium Glucose Cotransporter-2 Inhibitors: Systematic Review And Meta-analysis (ID 691)

 C.C. Cheung: Nothing relevant to disclose.


Background: Trials examining cardiovascular outcomes for sodium glucose cotransporter-2 (SGLT-2) inhibitors have demonstrated significant reductions in cardiovascular events and mortality. However, studies were not powered to assess the effect of SGLT-2 inhibitors on cardiac arrhythmia outcomes.
Objective: To determine the association between SGLT-2 inhibitors on cardiac arrhythmia outcomes.
Methods: We searched PubMed and Embase for randomized controlled trials (RCTs) with study duration of at least 24-weeks assessing the effect of SGLT-2 inhibitors on atrial fibrillation, atrial flutter, ventricular tachycardia, atrioventricular block, and/or sudden death. Using the search strategy, 419 references were identified. Following removal of duplicates, 365 abstracts were screened by at least two reviewers, and 98 articles were identified for full text review. Fixed effects meta-analyses using the Peto method were performed on the 10 studies that met eligibility criteria, as some studies had no events in the treatment or the control groups for the outcomes of interest.
Results: Systematic review identified 10 studies published between 2014-2019 that assessed the effect of dapagliflozin (7 studies), empagliflozin (2 studies), and canagliflozin (1 study). 17,938 individuals were treated with an SGLT-2 inhibitor and 15,484 individuals were treated with placebo. Risk of bias was assessed as low risk for most domains across the 10 studies.
Meta-analysis showed a significant protective effect of SGLT-2 inhibitors on atrial fibrillation (OR 0.74, 95% CI 0.59-0.94; 4 studies) and pooled arrhythmias (OR 0.80, 95% CI 0.67-0.95; 6 studies). There was no effect on atrial flutter (OR 0.81, 95% CI 0.49-1.36; 3 studies), ventricular tachycardia (OR 0.83, 95% CI 0.58-1.19; 3 studies), atrioventricular block (OR 1.20, 95% CI 0.61-2.37; 2 studies), or sudden death (OR 0.78, 95% CI 0.57-1.06; 6 studies).
Conclusion: Meta-analysis of RCTs studying the effect of SGLT-2 inhibitors demonstrated a significant reduction in pooled arrhythmias, and specifically, atrial fibrillation. Putative mechanisms may relate to maintenance of euvolemia, reduced cardiac stretch, and reduced cardiovascular outcomes.