Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 21, 2022; 10(3): 939-953
Published online Jan 21, 2022. doi: 10.12998/wjcc.v10.i3.939
Atrial fibrillation burden and the risk of stroke: A systematic review and dose-response meta-analysis
Sheng-Yi Yang, Min Huang, Ai-Lian Wang, Ge Ge, Mi Ma, Hong Zhi, Li-Na Wang
Sheng-Yi Yang, Min Huang, Ge Ge, Mi Ma, Department of Epidemiology and Biostatistics, Southeast University, Nanjing 210009, Jiangsu Province, China
Ai-Lian Wang, Yaohua Community Healthcare Center, Nanjing 210046, Jiangsu Province, China
Hong Zhi, Department of Cardiology, Zhongda Hospital, Nanjing 210009, Jiangsu Province, China
Li-Na Wang, School of Public Health, Southeast University, Nanjing 210009, Jiangsu Province, China
Author contributions: Yang SY and Huang M designed the search strategy, performed the literature search and collected the data; Yang SY wrote the manuscript; Ma M checked the data; Ge G performed quality assessment and reviewed the level of evidence; Wang LN designed the project and edited the manuscript; Zhi H helped revised the manuscript for language; Wang AL checked the data; all authors read and approved the manuscript.
Supported by National Natural Science Foundation of China, No. 81673259; and Natural Science Foundation of Jiangsu Province, China, No. BK20161435.
Conflict-of-interest statement: There is no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Na Wang, Doctor, Associate Professor, School of Public Health, Southeast University, No. 87 Ding Jiaqiao Road, Nanjing 210009, Jiangsu Province, China. lnwang@seu.edu.cn
Received: September 2, 2021
Peer-review started: September 2, 2021
First decision: October 11, 2021
Revised: October 26, 2021
Accepted: December 23, 2021
Article in press: December 23, 2021
Published online: January 21, 2022
ARTICLE HIGHLIGHTS
Research background

With the widespread use of cardiac implantable electronic devices and wearable devices, it is nowadays possible to monitor the atrial fibrillation (AF) burden. However, whether an AF burden of > 5 min can increase the risk of stoke is still highly controversial, and the potential linear or nonlinear relationship between them remains largely unexplored.

Research motivation

A comprehensive systemic review and meta-analysis can summarize the results of available studies and help doctors in the clinical decision-making process.

Research objectives

This meta-analysis aimed to determine the association between AF burden > 5 min and the increased risk of stroke and explore a dose-response effect of AF burden on the risk of stroke.

Research methods

Studies were identified by searching electronic databases (PubMed, EMBASE, Medline, Cochrane and Web of Science) from inception until February 28, 2020. The potential nonlinear dose-response association was evaluated using a restricted cubic splines regression model. AF burden was associated with an increased risk of stroke for every 1 h and 2 h. Trial sequential analysis with a random-effect model was used to evaluate the robustness of the evidence from the included 16 studies. Data from these studies were pooled using RevMan software and Stata.

Research results

The meta-analysis indicated that an 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] but was not associated with an increased risk of all-cause mortality (adjusted RR = 1.55, 95%CI: 0.87-2.75). Patients with an AF burden > 5 min had an increased risk of stroke (adjusted RR = 2.49, 95%CI: 1.79-3.47). The linear dose-response analysis showed that the risk of stroke was increased by 2.0% per hour as the AF burden was increased (Pnonlinear = 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 increased risk of stroke.

Research conclusions

AF burden is a significant risk factor for clinical AF and stroke. A significant linear association is present between increased AF burden and the risk of stroke.

Research perspectives

More emphasis should be laid on patients with AF burden to minimize the stroke risks.