SGLT-2i and Atrial Fibrillation in the Cardiovascular and Renal Outcome Trials.

Dapagliflozin is a sodium-glucose cotransporter-2 inhibitor (SGLT-2i) that has recently been shown to reduce the incidence of reported episodes of atrial fibrillation (AF)/atrial flutter in the DECLARE-TIMI 58 trial. This raises the question regarding whether SGLT-2i can reduce the incidence of AF in a high-risk population. We searched for trials comparing SGLT-2is to placebo in high-risk individuals with or without diabetes (i.e., cardiovascular and renal outcome trials) and that reported the incidence of AF as a serious adverse event. EMPA-REG OUTCOME trial, CANVAS, CANVAS-R, DECLARE-TIMI 58 trial, CREDENCE, DAPA-HF, VERTIS-CV, and DAPA-CKD were included. The incidence of AF, reported as a serious adverse event, was 0.9% in individuals who received an SGLT-2i compared to 1.1% in those who received placebo. Pooled results showed a significantly lower incidence of AF in individuals with and without diabetes (RR[95%CI]=0.79[0.67,0.93]). This review suggests that there is a significantly lower risk of incident AF for individuals on SGLT-2is versus placebo. While there was a statistically significant lower incidence of AF, reported as a serious adverse event, more research is needed to evaluate its clinical significance. This article is protected by copyright. All rights reserved.