Abstract：
Type 2 diabetes is associated with a higher risk of cardiac arrhythmias, especially in presence of cardiovascular disease and/or heart failure. Even if atrial fibrillation/flutter episodes are the most frequent and well-studied, ventricular arrhythmias (VA: tachycardia/fibrillation) are more severe and can lead to sudden cardiac arrest/death (SCA/SCD). The effects of glucose-lowering agents on the risk of VA/SCD remain poorly understood. Findings may be derived from experimental animal studies, randomised controlled trials/cardiovascular outcome trials and observational retrospective studies. A higher risk was attributed to hypoglycaemia when induced by insulin or even more critically by sulphonylureas. Insulin-secreting agents seem to be associated with a higher risk of cardiac arrhythmias compared with insulin sensitizers (metformin, thiazolidinediones), yet the risk linked to sulphonylureas remains controverted. Incretin-based therapies (DPP-4 inhibitors and GLP-1 receptor agonists) overall appear to be neutral regarding the risk of cardiac arrhythmias, despite some heterogeneous results. SGLT2 inhibitors appear to reduce the risk of SCA/SCD and possibly VA, yet only a non-significant trend was noticed in most reports. Overall, hazard ratios with SGLT2 inhibitors versus other therapies were lower for SCD (presumably of diverse causes) than for well demonstrated VA episodes. Underlying mechanisms remain uncertain and numerous pleiotropic effects may be involved. Prospective controlled trials and experimental studies specifically devoted to the effects of SGLT2 inhibitors on cardiac arrhythmias are needed to confirm their positive effects in diabetic patients and in individuals with heart failure irrespective of diabetes and, if possible, to carefully dissect the underlying protective mechanisms.
摘要：
2型糖尿病与心律失常的高风险相关，尤其是在存在心血管疾病和/或心力衰竭的情况下。即使心房颤动/扑动发作是最常见和研究最充分的，室性心律失常(VA:心动过速/纤颤)更为严重,可导致心脏骤停/死亡(SCA/SCD).降糖药对VA/SCD风险的影响仍然知之甚少。研究结果可能来自实验动物研究，随机对照试验/心血管结局试验和观察性回顾性研究.当胰岛素或磺脲类药物引起低血糖时，更高的风险归因于低血糖。与胰岛素增敏剂相比，胰岛素分泌剂似乎与心律失常的风险更高（二甲双胍，噻唑烷二酮)，然而，与磺脲类药物相关的风险仍存在争议。以肠促胰岛素为基础的治疗（DPP-4抑制剂和GLP-1受体激动剂）总体上似乎对心律失常的风险是中性的。尽管有一些不同的结果。SGLT2抑制剂似乎可以降低SCA/SCD和VA的风险，然而在大多数报告中只注意到一个非显著的趋势.总的来说,SGLT2抑制剂与其他治疗相比,SCD(可能是多种原因)的风险比低于经证实的VA发作.潜在机制仍不确定，可能涉及许多多效性效应。需要专门针对SGLT2抑制剂对心律失常的影响的前瞻性对照试验和实验研究，以证实其在糖尿病患者和心力衰竭患者中的积极作用，而不论糖尿病和糖尿病，如果可能,仔细剖析潜在的保护机制。
