Suresh Suchith Boodgere, Prasad Aishwarya, Ubaid Muhammad Furqan, Farooq Saad, Hajra Adrija, Jaiswal Vikash, Malik Aaqib, Fonarow Gregg C, Bandyopadhyay Dhrubajyoti
Internal Medicine, Montefiore St Luke's Cornwall, Newburgh, NY 12550, USA.
Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
J Clin Med. 2025 Jul 27;14(15):5306. doi: 10.3390/jcm14155306.
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have revolutionized heart failure (HF) therapies and are an essential component of guideline-directed medical therapy (GDMT); however, their significance in arrhythmia prevention is still uncertain. This meta-analysis evaluates the benefits of SGLT2i on arrhythmias in HF. A comprehensive examination was performed with PubMed, ScienceDirect, PLOS One, Cochrane, Google Scholar, and ClinicalTrials.gov from January 2014 to March 2025, complying with PRISMA guidelines. Randomized controlled trials (RCTs) comparing SGLT2i with placebo were incorporated. Primary results included ventricular arrhythmias (VA), sudden cardiac death (SCD), atrial arrhythmias, and conduction disorders. Subgroup analyses investigated the effects on arrhythmias in HF with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). A total of 11 RCTs involving 23,701 patients, 11,848 on SGLT2i (mean age: 68.26 ± 10 yrs, 53.5% males) and 11,853 on placebo (mean age: 67.91 ± 10 yrs, 53% males), were analyzed with a mean follow-up of 2.71 yrs. No significant differences were reported between SGLT2i and placebo for VA [relative risk (RR): 1.02, 95% confidence interval (CI): 0.83-1.25], I =0%), atrial arrhythmias (RR: 0.92 [CI: 0.67-1.27], I = 65.3%), or conduction disorders (RR:1.22 [CI: 0.86-1.73], I = 10.4%). Notably, significant reductions in risk of SCD (RR: 0.68 [CI: 0.49-0.93], I = 0%) and in the risk of atrial arrhythmias in HFrEF (RR: 0.66 [CI: 0.49-0.89], I = 10.3%) were witnessed, although no such reduction was seen in HFpEF (RR: 1.14 [CI: 0.94-1.40], I = 33.8%). SGLT2i do not reduce overall arrhythmia or conduction disorder risk in HF but significantly reduce the risk of SCD and atrial arrhythmias in HFrEF patients. These results highlight potential arrhythmia prevention benefits in HFrEF, warranting further targeted studies.
钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）彻底改变了心力衰竭（HF）的治疗方法，是指南导向药物治疗（GDMT）的重要组成部分；然而，它们在预防心律失常方面的意义仍不明确。这项荟萃分析评估了SGLT2i对HF患者心律失常的益处。我们按照PRISMA指南，于2014年1月至2025年3月期间，使用PubMed、ScienceDirect、PLOS One、Cochrane、谷歌学术和ClinicalTrials.gov进行了全面检索。纳入了比较SGLT2i与安慰剂的随机对照试验（RCT）。主要结果包括室性心律失常（VA）、心源性猝死（SCD）、房性心律失常和传导障碍。亚组分析研究了对射血分数降低的心力衰竭（HFrEF）和射血分数保留的心力衰竭（HFpEF）患者心律失常的影响。共分析了11项RCT，涉及23701例患者，其中11848例使用SGLT2i（平均年龄：68.26±10岁，男性占53.5%），11853例使用安慰剂（平均年龄：67.91±10岁，男性占53%），平均随访2.71年。SGLT2i与安慰剂在VA方面无显著差异[相对风险（RR）：1.（此处原文有误，应为1.02），95%置信区间（CI）：0.83-1.25，I² = 0%]、房性心律失常方面（RR：0.92 [CI：0.67-1.27]，I² = 65.3%）或传导障碍方面（RR：1.22 [CI：0.86-1.73]，I² = 10.4%）。值得注意的是，观察到SCD风险显著降低（RR：0.68 [CI：0.49-0.93]，I² = 0%），HFrEF患者房性心律失常风险显著降低（RR：0.66 [CI：0.49-0.89]，I² = 10.3%），尽管HFpEF患者未见此类降低（RR：1.14 [CI：0.94-1.4]，I² = 33.8%）。SGLT2i不会降低HF患者的总体心律失常或传导障碍风险，但可显著降低HFrEF患者的SCD和房性心律失常风险。这些结果凸显了HFrEF患者在预防心律失常方面的潜在益处，值得进一步开展针对性研究。
