Systemic lupus erythematosus increases risk of incident atrial fibrillation: A systematic review and meta-analysis

Int J Rheum Dis. 2022 Oct;25(10):1097-1106. doi: 10.1111/1756-185X.14403. Epub 2022 Jul 29.

Abstract

Background and objectives: Patients with systemic lupus erythematosus (SLE) might have increased risk of atrial fibrillation (AF) as a result of initiating chronic and systematic inflammation. However, the prevalence of AF in patients with SLE have not been well quantified. The aim of this systematic review and meta-analysis was to collect and identify available clinical data to explore this possible correlation.

Methods: Articles were searched based on electronic databases (PubMed, Scopus, ScienceDirect, Cochrane Library, Web of Science). Review Manager 5.4 was used to perform meta-analysis of all selected studies and subgroup analyses (pooled separately by geographical distribution). Pooled risk ratio (RR) and 95% confidence intervals (95% CI) were calculated by random-effect model or fix-effect model.

Results: Six cohort studies were involved in this meta-analysis, including 311 844 participants, 78 134 cases of SLE and 347 883 non-SLE controls. Pooled studies indicated increased risk of AF development in patients with SLE compared to participants without SLE (I2 = 96%, RR = 1.85; 95% CI: 1.23-2.79; P = .003). Four clinical trials including only European/ American populations were analyzed in subgroups. Heterogeneity analysis showed that I2 = 9% and there was an increase in the risk of AF development in European/ American patients with SLE (RR = 1.79; 95% CI: 1.61-1.98; P < .001), while in 2 Korean studies, the heterogeneity was 98% and there was no correlation between AF and SLE (RR = 1.81, 95% CI: 0.39-8.43). Five clinical studies were involved in subgroup analysis after excluding the Beak study, with I2 = 96% and they suggested that SLE increased the risk of AF development (RR = 2.13, 95% CI: 1.42-3.21, P = .002).

Conclusion: This meta-analysis suggested that SLE may be a risk factor for AF development and the results may vary with geographic distribution.

Keywords: atrial fibrillation; epidemiology; heterogeneity; meta-analysis; systemic lupus erythematosus.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Atrial Fibrillation* / diagnosis
  • Atrial Fibrillation* / epidemiology
  • Cohort Studies
  • Humans
  • Lupus Erythematosus, Systemic* / diagnosis
  • Lupus Erythematosus, Systemic* / epidemiology
  • Odds Ratio
  • Risk Factors