Abstract
Introduction: Ventricular arrhythmias, including their association with 18 F-fluorodeoxy-glucose (FDG) uptake on positron emission tomography/computed tomography (PET/CT) has been extensively studied in patients with cardiac sarcoidosis (CS), whereas atrial involvement and related arrhythmias have not been thoroughly investigated despite evidence of their occurrence. Research Questions/Aims: We herein sought to assess the prevalence, incidence, and characteristics of atrial fibrillation (AF) in patients with CS. We also examined the predictors of atrial arrythmias as well as its association with atrial inflammation as detected by 18 FDG-PET/CT. Methods: PubMed/Medline, Web of Science, and Scopus were systematically queried from inception until April 26th, 2023. Using the random-effects model, separate Forest and Galbraith plots were generated for each effect size assessed. Heterogeneity was assessed using the I 2 statistics whilst Funnel plots and Egger’s test were used to assess for publication bias. Results: From a total of 8 studies comprising 978 patients with CS, a random effects meta-analysis approximated the pooled summary estimates for the prevalence of AF to be 23% (95% CI: 13%-34%). Paroxysmal AF was the most common subtype of AF (83%; 95% CI: 77%-90%), followed by persistent AF (17%; 95% CI: 10% - 23%) from a total of 5 studies. One study estimated the prevalence of permanent AF at 12.5% (95% CI: 3.5%- 28.9%). In 9 studies involving 545 patients with CS, the cumulative pooled incident rate of AF was estimated at 13%, 25%, and 23% at <2years, 2-4years, and >4years of follow-up respectively. Increased left atrial size and atrial 18 F-FDG uptake were identified as strong independent predictors for the development of atrial arrythmias in patients with CS on qualitative synthesis. Conclusions: The burden of AF and related arrythmias in CS patients is considerable, with a heightened risk for adverse outcomes. This necessitates close follow-up and predictive risk-stratification tools to guide the initiation of appropriate strategies, including therapeutic interventions for primary prevention of AF-related embolic phenomenon, especially in those with known clinical predictors.
Published Version
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