The impact of sodium glucose cotransporter-2 inhibitors on ventricular arrhythmia in patients with implantable cardioverter-defibrillators: a meta analysis

INTRODUCTION: Sodium-glucose cotransporter-2 (SGLT2) inhibitors improve outcomes in heart failure (HF), but their effect on arrhythmias is less clear. Patients with implantable cardioverter-defibrillators (ICDs) are a high risk population for ventricular arrhythmias. However, the effects of SGLT2 inhibitors on ventricular arrhythmias remains a source of debate. METHODS: We systematically searched PubMed, Scopus, and Cochrane databases from inception to August 19, 2025, for studies evaluating SGLT2 inhibitors and arrhythmic/cardiovascular outcomes. Pooled mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. RESULTS: A total of 1,605 patients were included in our analysis. SGLT2 inhibitors was associated with a significant reduction in the risk of ventricular arrhythmia (RR: 0.38; 95% CI: 0.17 to 0.81; p = 0.01), ventricular tachycardia (RR: 0.60; 95% CI: 0.41 to 0.88; p = 0.009), and supraventricular tachycardia (RR: 0.67; 95% CI: 0.47 to 0.95; p = 0.02). No significant effect was observed on non-sustained VT (RR: 0.94; 95% CI: 0.52 to 1.67; p = 0.83). However, SGLT2 inhibitors were also associated with a significant reduction in ICD shocks (RR: 0.49; 95% CI: 0.38 to 0.64; p < 0.00001) and cardiovascular mortality (RR: 0.39; 95% CI: 0.22 to 0.70; p = 0.002). CONCLUSION: In ICD patients, SGLT2 inhibitor therapy significantly reduced ventricular arrhythmias, discrete sustained VT, and SVT, with secondary analyses suggesting fewer ICD shocks and reduction in CV mortality in the patients with ICD.