The Efficacy Of Sodium Glucose Co-Transporter 2 Inhibitors In Atrial Fibrillation: A Systematic Review And Meta-Analysis Of Randomized Controlled Trials

Background: Atrial Fibrillation (AF) is common in patients with Type 2 diabetes mellitus and it is associated with adverse outcomes. The impact of SGLT-2 inhibitors on incident AF and cardiovascular outcomes is unknown. Methods: A systematic review of Medline, EMBASE and other online sources was conducted on 04/22/2020. All randomized controlled trials (RCTs) comparing SGLT-2 to placebo reporting incident AF were included. Mantel Haenszel random effects modeling was used to estimate risk ratios (RR) and I 2 statistics were used to assess heterogeneity. Results: A total of 33 RCTs (n=65,505 patients) were included. SGTL-2 inhibitor (canagliflozin, dapagliflozin, empagliflozin, ertugliflozin) use was not associated with statistically significant benefit in preventing AF [RR 0.91 (0.80-1.04)] (Figure-1). Subgroup analysis showed that only Dapagliflozin had a statistically significant effect in preventing AF [RR 0.79 (0.66-0.93), p=0.006, I 2 =0%] (p<0.05 compared to others). SGLT-2 inhibitors were associated with a 25% relative risk reduction in the composite outcome of CV mortality or CV hospitalization in patients with history of AF [RR 0.75 (0.62-0.90)] and 27% in patients with no history of AF [RR 0.73 (0.66-0.81)]. Conclusion: SGLT-2 inhibitors prevent adverse cardiovascular outcomes regardless of baseline AF status. The protective effects of SGLT-2 inhibitors in preventing AF appear limited to Dapagliflozin.