Celiac Disease and Risk of Atrial Fibrillation: A Meta-Analysis

Abstract

Introduction: Several studies have found that Celiac Disease may be associated with a variety of cardiac manifestations. Atrial fibrillation(AF) is one of the most common arrhythmias that can cause significant morbidity. However, the risk of atrial fibrillation in patients with celiac disease according to epidemiological studies remains unclear. We performed this meta-analysis to assess the risk of atrial fibrillation in patients diagnosed with celiac disease compared to controls. Methods: A systematic review was conducted in MEDLINE, EMBASE, Cochrane databases from inception through December 2017 to identify studies that evaluated the risk of atrial fibrillation in patients with celiac disease using search terms for ‘atrial fibrillation, ‘supraventricular tachycardia’, ‘tachyarrhythmia’, ‘gluten enteropathy’, ‘gluten sensitive’ and ‘celiac disease’. Inclusion criteria:1) RCT, cohort (either prospective or retrospective), case-control study or cross sectional study published as original study 2) odds ratios (OR), relative risk (RR), hazard ratio (HR), and standardized incidence ratio (SIR) 3) subjects without celiac disease were used as comparators in cohort and cross-sectional study. The Newcastle-Otawa scale was used to determine the quality of the studies. Effect estimates from the individual study were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird. Results: Four observational studies with a total of 64,397 participants were enrolled. Compared with controls, celiac disease was associated with significantly increased risk of atrial fibrillation with a pooled OR of 1.38 (95% CI, 1.01 - 1.88). Celiac disease is an autoimmune condition, its inflammatory state predispose patient to develop AF. We found no publication bias as assessed by the funnel plots and Egger's regression asymmetry test with p= 0.54. However, the heterogeneity of the included studies was high (I2=96). Conclusion: Celiac disease is associated with 38% increased risk of atrial fibrillation. Additional studies are needed to clarify the mechanistic link between atrial fibrillation and autoimmune diseases. Some of the limitations of this study are that all were observational studies, some were medical registry-based. There was high heterogeneity between studies1163_A Figure 1. Studies selection criteria1163_B Figure 2. Adjusted Odds ratio.