SGLT-2 Inhibitors’ Antiarrhythmic Benefits in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis

Abstract

Background: Cardiac arrhythmias, particularly postoperative atrial fibrillation (POAF), are frequent and serious complications following cardiac surgery. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors have demonstrated antiarrhythmic potential, but their efficacy in the perioperative setting remains unclear. This systematic review and meta-analysis aimed to evaluate the evidence on the potential antiarrhythmic effects of SGLT-2 inhibitors in patients undergoing cardiac surgery. Methods: A systematic search across PubMed, Scopus, Web of Science, Embase, and Cochrane was conducted to capture relevant articles on randomized controlled trials (RCTs) and observational studies comparing SGLT-2 inhibitors to placebo or standard care in adult patients undergoing cardiac surgeries. The primary outcome was the incidence of postoperative arrhythmias, focusing on POAF. The systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement, and the search protocol was registered in PROSPERO, code: CRD420251117844. Comprehensive Meta-Analysis (CMA) software (version 3.0) was used for the meta-analysis. Results: Eleven studies were included in the systematic review: five RCTs, one secondary analysis of an RCT, and five observational studies. The meta-analysis of three observational studies (n = 6,310) demonstrated that the use of SGLT-2 inhibitor was associated with a significantly lower risk of POAF (Risk Ratio [RR]: 0.79; 95% CI: 0.70–0.89; P < 0.001). In contrast, the meta-analysis of three RCTs (n = 282) showed a trend towards a reduction in POAF that did not reach statistical significance (RR: 0.73; 95% CI: 0.47–1.13; P = 0.154). The safety profile of SGLT-2 inhibitors was favorable. Conclusion: This systematic review and meta-analysis, the first of its kind, suggests that SGLT-2 inhibitors may reduce the risk of POAF after cardiac surgery, a finding supported by the observational data. However, evidence from the RCTs is currently inconclusive. Further studies are warranted to definitively establish the antiarrhythmic role of SGLT-2 inhibitors in this context.

Keywords: SGLT-2 inhibitors, Postoperative Atrial Fibrillation, Cardiac Surgery, Antiarrhythmic Effects, Meta-analysis