Sodium-glucose cotransporter 2 (
SGLT2) inhibitors have well-documented effects on reducing hospitalization for
heart failure and cardiovascular mortality, although the effect on
atrial fibrillation (AF) has not been comprehensively investigated. Therefore, we performed a meta-analysis to assess the association between
SGLT2 inhibitors and AF risk by systematically searching PubMed, Embase, and ClinicalTrials.gov. Two investigators independently identified randomized controlled trials, which compared
SGLT2 inhibitors with control in patients with
type 2 diabetes,
heart failure, or
chronic kidney disease. Primary outcomes were incident AF and
stroke. We included 20 randomized trials involving 63,604 patients. The
SGLT2 inhibitors used were
dapagliflozin (7 studies, 28,834 patients),
canagliflozin (7 studies, 17,440 patients),
empagliflozin (5 studies, 9082 patients), and
ertugliflozin (1 study, 8246 patients). Follow-up ranged from 24 weeks to 202 weeks.
SGLT2 inhibitors treatment was associated with a significant attenuation in the risk of incident AF (odds ratio = 0.82; 95% confidence interval, 0.72-0.93; P = 0.002) compared with control. No significant difference in
stroke between
SGLT2 inhibitors and control groups was found (odds ratio = 0.99; 95% confidence interval, 0.85-1.15; P = 0.908). This present meta-analysis indicates that
SGLT2 inhibitors are associated with a lower risk of incident AF and do not significantly affect
stroke risk for patients with and without
type 2 diabetes.