Safety profile of finerenone: Pooled analysis of different types of arrhythmic events

Background Finerenone reduces kidney and cardiovascular events in patients with chronic kidney disease and type 2 diabetes mellitus, but its safety profile in terms of arrhythmic outcomes remains uncertain. Methods We systematically searched PubMed, Cochrane Library, and ClinicalTrials.gov (inception–March 2026) for randomized trials reporting arrhythmias or conduction disorders with finerenone versus control. Risk ratios (RRs) were pooled using fixed-effects models; heterogeneity was assessed with I2. Results Six trials (21,015 patients; mean age 67.2 years; 33.9% women) were included. Finerenone was not associated with increased atrial or ventricular arrhythmias, high-grade atrioventricular block, or cardiac arrest (all RRs non-significant; low heterogeneity). Conclusions Finerenone shows no clear increase in clinically reported arrhythmic events in the pooled analysis; however, the included studies were not designed to assess the rate of arrhythmic outcomes and might have underestimated the true rates.