Association between sodium-glucose cotransporter-2 inhibitors and incident atrial fibrillation/atrial flutter in heart failure patients with reduced ejection fraction: a meta-analysis of randomized controlled trials

• Published in: Heart failure reviews 2023-07, Vol.28 (4), p.925-936
• Main Authors: Sfairopoulos, Dimitrios, Liu, Tong, Zhang, Nan, Tse, Gary, Bazoukis, George, Letsas, Konstantinos, Goudis, Christos, Milionis, Haralampos, Vrettos, Apostolos, Korantzopoulos, Panagiotis
• Format: Article
• Language: English
• Subjects: Atrial Fibrillation - complications; Atrial Fibrillation - drug therapy; Atrial Fibrillation - epidemiology; Atrial Flutter - complications; Atrial Flutter - drug therapy; Atrial Flutter - epidemiology; Cardiac arrhythmia; Cardiology; Clinical trials; Congestive heart failure; Ejection fraction; Fibrillation; Glucose; Heart failure; Heart Failure - complications; Heart Failure - drug therapy; Heart Failure - epidemiology; Humans; Medicine; Medicine & Public Health; Meta-analysis; Na+/glucose cotransporter; Placebos; Randomized Controlled Trials as Topic; Sodium; Treatment Outcome; Ventricular Dysfunction, Left - complications
• ISSN: 1573-7322; 1382-4147; 1573-7322
• DOI: 10.1007/s10741-022-10281-3

Atrial fibrillation (AF) and atrial flutter (AFL) are associated with adverse outcomes in patients with heart failure and reduced ejection fraction (HFrEF). We investigated the effects of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on the incidence of AF and/or AFL in HFrEF patients. PubMed and ClinicalTrials.gov were systematically searched until March 2022 for randomized controlled trials (RCTs) that enrolled patients with HFrEF. A total of six RCTs with 9467 patients were included ( N  = 4731 in the SGLT2i arms; N  = 4736 in the placebo arms). Compared to placebo, SGLT2i treatment was associated with a significant reduction in the risk of AF [relative risk (RR) 0.62, 95% confidence interval CI 0.44–0.86; P  = 0.005] and AF/AFL (RR 0.64, 95% CI 0.47–0.87; P  = 0.004). Subgroup analysis showed that empagliflozin use resulted in a significant reduction in the risk of AF (RR 0.55, 95% CI 0.34–0.89; P  = 0.01) and AF/AFL (RR 0.50, 95% CI 0.32–0.77; P  = 0.002). By contrast, dapagliflozin use was not associated with a significant reduction in the risk of AF (RR 0.69, 95% CI 0.43–1.11; P  = 0.12) or AF/AFL (RR 0.82, 95% CI 0.53–1.27; P  = 0.38). Additionally, a “shorter” duration (