The presence of atrial fibrillation in Takotsubo cardiomyopathy is predictive of mortality: Systematic review and meta‐analysis

Introduction Atrial fibrillation (AF) is known as the most common arrhythmia and an independent risk factor for mortality. Recent studies suggest that AF is associated with morbidity and mortality in Takotsubo cardiomyopathy (TTC). However, a systematic review and meta‐analysis of the literature have not been done. We assessed the association between AF in patients with TTC and mortality by a systematic review of the literature and a meta‐analysis. Methods We comprehensively searched the databases of MEDLINE and EMBASE from inception to January 2018. Included studies were published prospective or retrospective cohort studies that compared all‐cause mortality in TTC with AF versus without AF. Data from each study were combined using the random‐effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals. Results Five studies from August 2008 to October 2017 were included in this meta‐analysis involving 2,321 subjects with TTC (243 with AF and 2,078 without AF). The presence of AF was associated with all‐cause mortality (pooled odds ratio = 2.19, 95% confidence interval: 1.57–3.06, p < 0.001, I 2 = 0%). Conclusion Atrial fibrillation increased all‐cause mortality by double among patients with TTC compared to without it. Our study suggests that the presence of AF in TTC is prognostic for all‐cause mortality.