A meta-analysis of ECG abnormalities (arrhythmias) in different types of heart failure

Abstract

The present paper performed a meta-analysis of 11 heart failure (HF) registries and 22 studies (N=292,927; mean age=71.8 years; females=43%) that evaluated arrhythmias in HF. The aim was to determine the prevalence and common types of arrhythmias in different forms of HF. Despite the prevalence of arrhythmias in all forms of heart failure (HF) and their association with a substantial risk of hospitalization, morbidity, and mortality, the search for studies finds that ECG-defined arrhythmias remain an understudied pathology in HF populations. Original studies on arrhythmias in HF populations are lacking, with a majority only reporting atrial fibrillation (AF) and ventricular tachycardia or fibrillation (VT/VF) during index admission as the underlying disease or precipitating factor. VT/VF received disproportionate focus because they confer substantial risk of thromboembolism and sudden cardiac death, respectively. The event rate of AF was 32.7% (95% CI: 31.1-34.3) and VT was 32.0% (95% CI: 12.2-61.3) in the 11 registries and AF occurred in 32.7% (95% CI: 32.5-33.0) in the 22 HF studies. Data on the prevalence of other forms of arrhythmias was either unavailable or insufficient for a pooled analysis. The prevalence of AF was observed in hypertensive HF, HF with reduced/ preserved ejection fraction, right HF, systolic HF, ischemic HF, and thyrotoxic HF. Given that arrhythmias can be both a cause and a consequence of HF, it is important to determine the prevalence of the different types of arrhythmias in different HF populations to improve diagnosis and refine management. Our present findings reveal that studies evaluating VT among HF patients are lacking. The study of ventricular arrhythmias is complicated by its broad-spectrum, which ranges from isolated and asymptomatic ventricular ectopy on ECG to fatal VF. Together with VA's high spontaneous variability, the assessment of the prevalence and incidence of Vas in the HF population becomes extremely difficult, explaining the paucity of studies on VA in HF. However, the VA may be more common in patients with ischemic HF and severely reduced