Atrial fibrillation burden and the risk of stroke: A systematic review and dose-response meta-analysis

• Published in: World journal of clinical cases Vol. 10; no. 3; pp. 939 - 953
• Main Authors: Yang, Sheng-Yi, Huang, Min, Wang, Ai-Lian, Ge, Ge, Ma, Mi, Zhi, Hong, Wang, Li-Na
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 21.01.2022
• Subjects: Systematic Reviews; Dose-response; Risk; Stroke; Atrial fibrillation; Meta-analysis
• ISSN: 2307-8960; 2307-8960
• DOI: 10.12998/wjcc.v10.i3.939

The increased stroke risk associated with atrial fibrillation (AF) burden exceeding 5 min is a matter of debate. In addition, the potential linear or nonlinear relationship between AF burden and stroke risk has been largely unexplored. To determine the association between AF burden > 5 min and the increased risk of stroke and explore the potential dose-response relationship between these two factors. Sixteen studies from six databases with 53141 subjects (mean age 65 years) were included. Fifteen studies were observational studies, and one was a randomized controlled trial study. The potential nonlinear dose-response association was characterized using a restricted cubic splines regression model. AF burden for each 1 h and 2 h was associated with an increased risk of stroke. Trial sequential analysis with a random-effect model was used to evaluate the robustness of the evidence from the included 16 studies. AF burden > 5 min was associated with an increased risk of clinical AF [adjusted risk ratio (RR) = 4.18, 95% confidence interval (CI): 2.26-7.74]. However, no association was found with an increased risk of all-cause mortality (adjusted RR = 1.55, 95%CI: 0.87-2.75). Patients with AF burden > 5 min had an increased risk of stroke (adjusted RR = 2.49, 95%CI: 1.79-3.47). Moreover, a dose-response analysis showed that the increased stroke risk was paralleled by an increase in AF burden at a rate of 2.0% hour ( = 0.656, RR = 1.02, 95%CI: 1.01-1.03). Trial sequential analysis provided robust evidence of the association between AF burden > 5 min and an increased risk of stroke. AF burden was a significant risk factor for clinical AF and future stroke. A significant linear association was documented between increased AF burden and risk of future stroke.