Risk of Incident Atrial Fibrillation after COVID-19 Infection: a Systematic Review and Meta-Analysis.

BACKGROUND: Data regarding the risk of atrial fibrillation (AF) during the post-acute phase of COVID-19 are lacking. OBJECTIVE: We assess 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 PRIMSA 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 to non-infected patients who developed the arrhythmia over the same follow-up period. AF risk was evaluated using the Mantel-Haenszel random effects models with Hazard ratio (HR) as the effect measure with 95% confidence interval (CI) while heterogeneity was assessed using Higgins I2 statistic. RESULTS: Overall, 19,478,173 patients (mean age 56.5 years, 63.0% males), enrolled in five observational studies, were included into the analysis. Among them, 5,692,510 recovered from SARS-CoV-2 infection. Over a mean follow-up of 14.5±3.2 months, a random effect model revealed a pooled incidence of new onset AF 2.6% of cases (95% CI: 1.8-6.18%). Recovered COVID-19 patients presented a higher risk of incident AF (HR: 1.57, 95% CI: 1.24-1.99, p<0.0001, I2=77.9%) compared to non-infected patients over the same follow-up period. Sensitivity analyses confirmed yielded results. A multivariable meta-regression, including age, male sex, history of hypertension, coronary artery disease and length of follow-up was able to explain a significant part of heterogeneity (R2: 54.3%, p=0.01). CONCLUSIONS: Recovered COVID-19 patients have a higher risk of AF events compared to subjects from the general population.