Risk of incident atrial fibrillation after COVID-19 infection: A systematic review and meta-analysis

Marco Zuin; Luisa Ojeda-Fernández; Ginevra Torrigiani; Matteo Bertini

doi:10.1016/j.hrthm.2024.04.064

Risk of incident atrial fibrillation after COVID-19 infection: A systematic review and meta-analysis

Heart Rhythm. 2024 Apr 16:S1547-5271(24)02391-9. doi: 10.1016/j.hrthm.2024.04.064. Online ahead of print.

Authors

Marco Zuin¹, Luisa Ojeda-Fernández², Ginevra Torrigiani², Matteo Bertini³

Affiliations

¹ Division of Cardiology, University of Ferrara, Ferrara, Italy.
² Laboratory of Cardiovascular Prevention, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
³ Division of Cardiology, University of Ferrara, Ferrara, Italy. Electronic address: matteo.bertini@unife.it.

PMID: 38636931
DOI: 10.1016/j.hrthm.2024.04.064

Abstract

Background: Data regarding the risk of atrial fibrillation (AF) during the post-acute phase of COVID-19 are lacking.

Objective: We assessed the risk of incident AF in COVID-19 recovered patients by performing a systematic review and meta-analysis of the available data.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched Medline and Scopus to locate all articles published up to December 10, 2023, reporting the risk of AF in patients recovered from COVID-19 infection compared with noninfected patients in whom the arrhythmia developed during the same follow-up period. AF risk was evaluated by the Mantel-Haenszel random effects model with hazard ratio as the effect measure with 95% confidence interval (CI); heterogeneity was assessed by Higgins I² statistic.

Results: Overall, 19,478,173 patients (mean age, 56.5 years; 63.0% male) enrolled in 5 observational studies were included in the analysis. Of these, 5,692,510 recovered from severe acute respiratory syndrome coronavirus 2 infection. During a mean follow-up of 14.5 ± 3.2 months, a random effects model revealed a pooled incidence of new-onset AF in 2.6% of cases (95% CI, 1.8%-6.18%). Recovered COVID-19 patients presented with a higher risk of incident AF (hazard ratio, 1.57; 95% CI, 1.24-1.99; P < .0001; I² = 77.9%) compared with noninfected patients during the same follow-up period. Sensitivity analyses confirmed the yielded results. A multivariable metaregression including age, male sex, history of hypertension, coronary artery disease, and length of follow-up was able to explain a significant part of the heterogeneity (R² = 54.3%; P = .01).

Conclusion: Recovered COVID-19 patients have a higher risk of AF events compared with individuals from the general population.

Keywords: Arrhythmias; Atrial fibrillation; COVID-19; Follow-up; Sequelae.