AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Sodium Glucose Cotransporter 2 Inhibitors and Ventricular Arrhythmias in Patients with an Implantable Cardioverter Defibrillator: A Systematic Review and Meta-Analysis
By Haddad E, Nugooru S, Elmorsy R et al.
Background: Emerging evidence suggests that sodium-glucose cotransporter-2 (SGLT2) inhibitors exhibit antiarrhythmic properties through mechanisms including direct inhibition of the cardiac late sodium current, and indirect contribution through their antifibrotic effects. Major benefits of SGLT-2 inhibitors were seen with decreasing arrhythmogenic burden in atrial fibrillation. However, their impact on ventricular arrhythmias (VA), specifically in patients carrying an implantable cardioverter-defibrillator (ICD) or CRT-D, a population at high arrhythmic risk, has not been definitively quantified. We performed a systematic review and meta-analysis to estimate the effect of SGLT2 inhibitors on device-detected VA and related therapies. Methods: We searched MEDLINE, Embase, and CENTRAL, with trial registries and congress proceedings, for randomized and observational studies comparing an SGLT2 inhibitor with placebo, usual care, or a pre-treatment period in adults with an ICD/CRT-D reporting VA or device-therapy outcomes. Two reviewers screened, extracted data, and assessed risk of bias (RoB 2; ROBINS-I). Random-effects models (REML) pooled risk ratios (RR) with 95% confidence intervals; heterogeneity was summarized with I ² . Outcomes were total VA, ventricular tachycardia (VT), supraventricular tachycardia (SVT), appropriate ICD therapy/shocks, and cardiovascular mortality. Results: Six studies (three randomized controlled trials and three observational studies) comprising 1,605 patients met inclusion criteria. SGLT2 inhibitor therapy was associated with a significantly lower risk of total ventricular arrhythmia (RR 0.38, 95% CI 0.17-0.81; I ² =0%) and ventricular tachycardia (RR 0.60, 95% CI 0.41-0.88; I ² =23%). Supraventricular tachycardia was also reduced (RR 0.67, 95% CI 0.47-0.95; I ² =0%). Patients receiving an SGLT2 inhibitor had fewer appropriate ICD therapies/shocks (RR 0.49, 95% CI 0.38-0.64; I ² =0%) and lower cardiovascular mortality (RR 0.39, 95% CI 0.22-0.70; I ² =0%). Effects were directionally consistent across randomized and observational studies, with low statistical heterogeneity. Conclusion: In patients with an ICD or CRT-D, SGLT2 inhibitor therapy is associated with significant reductions in ventricular arrhythmias, appropriate device therapies, and cardiovascular mortality. These findings support a clinically meaningful antiarrhythmic benefit and warrant confirmation in adequately powered randomized trials with prespecified device-based endpoints.