Abstract 12013: Cardiac Arrhythmia After COVID-19 Vaccination versus Non-COVID-19 Vaccination: A Systematic Review and Meta-Analysis

Abstract

Introduction: Arrhythmia after COVID-19 vaccination is increasingly reported. Whether the risk from COVID-19 vaccines exceeds that of non–COVID-19 vaccines remains controversial. In this study, the incidence of arrhythmia after COVID-19 versus non–COVID-19 vaccination were investigated. Methods: Medline (via PubMed), Scopus, Cochrane Library, and Embase databases were searched for observational studies reporting the incidence of postvaccination arrhythmias from January 1, 1947 to November 27, 2022. Secondary endpoints included tachyarrhythmia incidence and all-cause mortality. Arrhythmia incidence by age, vaccine type, sex, and COVID-19 vaccine dose were analysed, and intrastudy risk for bias and certainty of evidence were evaluated. Results: The overall incidence of arrhythmia (1,528,500,116 vaccine doses, 43 studies) was 561·3 cases per million doses. Arrhythmias were more common after COVID-19 vaccination than non–COVID-19 vaccination (3790·4 vs 13·7 cases per million doses; p<0·001). Compared with COVID-19 vaccines, the influenza, pertussis, and human papillomavirus vaccines were associated with fewer cases of arrhythmia. The overall incidence of tachyarrhythmia was 910·5 cases per million doses; it was higher after COVID-19 vaccination than non-COVID-19 vaccination (6681·8 vs 34·3 cases per million doses; p<0·001). Pooled all-cause mortality postvaccination was 2·4 deaths per million doses. Mortality was comparable between COVID-19 and non–COVID-19 vaccination groups. Conclusions: Although arrhythmia was more frequent after COVID-19 vaccination than after non-COVID-19 vaccination, it was still uncommon. The safety and efficacy of COVID-19 vaccines should be assessed in light of other important factors as well, such as the incidence of regional outbreaks and effects from the COVID-19 infection itself.