Risk of incident atrial fibrillation in patients with rheumatoid arthritis: a systematic review and meta-analysis

Aims: Patients with rheumatoid arthritis (RA) might be at an increased risk of developing atrial fibrillation (AF) as a result of deleterious effects of inflammatory cytokines on cardiomyocytes. This study aimed to comprehensively review all available evidence to further characterize this possible association. Methods: We conducted a systematic review and meta-analysis of cohort studies that reported relative risk, hazard ratio, incidence ratio or standardized incidence ratio with 95% confidence intervals comparing the risk of incidence of AF in patients with RA versus non-RA participants. Pooled risk ratio and 95% confidence interval were calculated using random-effect, generic inverse-variance methods of DerSimonian and Laird. Results: Three retrospective cohort studies with 39 912 cases of RA and 4 269 161 non-RA controls were included in the data analysis. The pooled risk ratio of subsequent development of AF in patients with RA versus controls was 1.29 (95% CI, 1.05-1.59). The statistical heterogeneity was moderate with an I 2 of 71%. Conclusion: Our meta-analysis demonstrated a statistically significant increased risk of subsequent development of AF among patients with RA.