SGLT2 Inhibitor Effects on Cardiac Arrhythmias
Summary
Sodium–glucose cotransporter 2 (SGLT2) inhibitors were developed to enhance glycaemic control in type 2 diabetes, but clinical experience and experimental data have revealed a marked reduction in both atrial and ventricular arrhythmias. Large-scale meta-analyses demonstrate consistent decreases in atrial fibrillation, atrial flutter and ventricular tachycardia across diverse patient populations with diabetes, heart failure or chronic kidney disease. Mechanistic studies attribute antiarrhythmic actions to direct modulation of cardiomyocyte electrophysiology—particularly inhibition of late sodium current and reduction of action potential excitability—as well as to favourable effects on myocardial inflammation, ionic homeostasis and mitochondrial function. Observational cohorts and randomised-trial substudies report lower rates of device therapies, cardioversions and sudden cardiac death. These findings carry global significance, suggesting a novel role for SGLT2 inhibitors beyond glucose lowering in preventing arrhythmic complications and improving cardiovascular outcomes.
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SGLT2 Inhibitor Effects on Cardiac Arrhythmias publication trend
The graph below shows the total number of articles in sglt2 inhibitor effects on cardiac arrhythmias across all publications each year (not limited to Nature Index journals).
Technical terms
SGLT2 inhibitor: A drug that blocks renal sodium–glucose cotransporter 2, lowering blood glucose and exerting extra-glycaemic cardiovascular effects.
Atrial fibrillation: A rapid and irregular atrial rhythm leading to disorganised atrial contraction and increased stroke risk.
Ventricular tachycardia: A fast heart rhythm originating in the ventricles, which may deteriorate to ventricular fibrillation and sudden death.
Action potential: The transient change in cardiomyocyte membrane voltage that underlies excitation and contraction.
Late sodium current: A persistent inward sodium ion flow during repolarisation that can prolong action potentials and promote arrhythmia.
References
- Acute antiarrhythmic effects of SGLT2 inhibitors–dapagliflozin lowers the excitability of atrial cardiomyocytes. Basic Research in Cardiology (2024).
- Association between sodium–glucose cotransporter-2 inhibitors and arrhythmic outcomes in patients with diabetes and pre-existing atrial fibrillation. EP Europace (2024).
- Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and cardiac arrhythmias: a systematic review and meta-analysis. Cardiovascular Diabetology (2021).
- Cardiac Late Sodium Channel Current Is a Molecular Target for the Sodium/Glucose Cotransporter 2 Inhibitor Empagliflozin. Circulation (2021).
- Effect of dapagliflozin on ventricular arrhythmias, resuscitated cardiac arrest, or sudden death in DAPA-HF. European Heart Journal (2021).
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