Embolic Complications of Cardiac Myxoma: A Systematic Review and Meta-analysis of Frequency, Clinical Characteristics, Anatomical Distribution and Outcomes in Contemporary Cohorts (Preprint)

Background: Cardiac myxomas (CMs) are the most common benign primary cardiac tumours, most frequently originating from the left atrium, and less commonly from the right atrium. Despite being histologically benign, CMs can cause serious thromboembolic complications including stroke, acute coronary syndrome, limb ischemia, and visceral infarction. While previous studies have explored risk factors for thromboembolism, literature comprehensively synthesising the anatomical distribution, clinical patterns, and management of CMs remains limited. Objective: We intend to summarise the published evidence on the frequency, anatomical distribution, clinical presentations, and management implications of thromboembolic events associated with CMs. Methods: A systematic review will be conducted in accordance with PRISMA-P guidelines and registered on PROSPERO. Medline, Embase, and PubMed will be searched for studies reporting thromboembolic complications in patients with histologically or radiologically confirmed CMs. Eligible study designs include case reports, case series, cohort studies, and registries. Two reviewers will independently screen studies and extract data on patient demographics, tumour characteristics, embolic events (type, site, clinical presentation), diagnostics, management, and outcomes. Discrepancies will be resolved through discussion or third-party adjudication. Risk of bias will be assessed using Joanna Briggs Institute tools. Results: The review will summarise reported frequencies and anatomical distribution of embolic events, clinical presentations, associations with tumour characteristics, and management strategies. Case reports will be tabulated individually, while cohort and series data will be aggregated descriptively with quantitative summaries presented where feasible. Conclusions: This review aims to provide a comprehensive synthesis of thromboembolic complications associated with CMs, highlighting patterns, management strategies, and gaps in the current literature. Findings aim to improve clinical recognition, inform clinical management, and guide future research. Clinical Trial: This study is a systematic review and not a clinical trial. The review protocol was prospectively registered with PROSPERO (CRD420261299634).