A systematic review and meta‐analysis of new‐onset atrial fibrillation in the context of COVID‐19 infection

Sawai Singh Rathore; Akanksha Atulkar; Kavya Remala; Vanessa Vidaurre Corrales; Ameer Mustafa Farrukh; Ravinderjeet Kaur Puar; Sem Josue Nsanh Yao; Vijaya Durga Pradeep Ganipineni; Nirmal Patel; Naganath Thota; Ashish Kumar; Abhishek Deshmukh

doi:10.1111/jce.16169

January 7, 2024Journal of Cardiovascular ElectrophysiologyOpen Access

A systematic review and meta‐analysis of new‐onset atrial fibrillation in the context of COVID‐19 infection

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Why the study?

New-onset atrial fibrillation in COVID-19 raises significant clinical and public health issues, warranting a comprehensive understanding of its prevalence and outcomes.

Does new-onset atrial fibrillation increase the risk of severe disease and mortality in COVID-19 patients?

Structured PICO

Does new-onset atrial fibrillation increase the risk of severe disease and mortality in COVID-19 patients?

P

Population

81,929 COVID-19 patients pooled from 30 articles

I

Intervention

New-onset atrial fibrillation (NOAF)

C

Comparator

COVID-19 patients without a history of atrial fibrillation and COVID-19 patients with pre-existing atrial fibrillation

O

Outcome

Prevalence of NOAF, severe disease, and all-cause mortalityhard clinical

New-onset atrial fibrillation in COVID-19 patients is associated with a significantly higher risk of severe illness and all-cause mortality compared to patients with no AF or pre-existing AF.

Implication

NOAF in COVID-19 signals higher mortality; confirms association in pooled data and supports prospective management trials.

Abstract

New-onset atrial fibrillation (NOAF) in COVID-19 raises significant clinical and public health issues. This systematic review and meta-analysis aims to compile and analyze the current literature on NOAF in COVID-19 and give a more comprehensive understanding of the prevalence and outcomes of NOAF in COVID-19. A comprehensive literature search was carried out using several databases. The random effect model using inverse variance method and DerSimonian and Laird estimator of Tua2 was used to calculate the pooled prevalence and associated 95% confidence interval (CI). Results for outcome analysis were presented as odds ratios (ORs) with 95% CI and pooled using the Mantel-Haenszel random-effects model. The pooled prevalence of NOAF in COVID-19 was 7.8% (95% CI: 6.54%-9.32%),a pooled estimate from 30 articles (81 929 COVID-19 patients). Furthermore, our analysis reported that COVID-19 patients with NOAF had a higher risk of developing severe disease compared with COVID-19 patients without a history of atrial fibrillation (OR = 4.78, 95% CI: 3.75-6.09) and COVID-19 patients with a history of pre-existing atrial fibrillation (OR = 2.75, 95% CI: 2.10-3.59). Similarly, our analysis also indicated that COVID-19 patients with NOAF had a higher risk of all-cause mortality compared with, COVID-19 patients without a history of atrial fibrillation (OR = 3.83, 95% CI: 2.99-4.92) and COVID-19 patients with a history of pre-existing atrial fibrillation (OR = 2.32, 95% CI: 1.35-3.96). The meta-analysis did not reveal any significant publication bias. The results indicate a strong correlation between NOAF and a higher risk of severe illness and mortality. These results emphasize the importance of careful surveillance, early detection, and customized NOAF management strategies to improve clinical outcomes for COVID-19 patients.