Incidence and prognostic significance of atrial fibrillation in patients with tako-tsubo syndrome-systematic review and meta-analysis.

Background: Tako-tsubo syndrome (TTs) is relatively young cardiovascular entity, being initially described in the 1991 by dr Hikaru Sato. Most patients with TTs are admitted to the hospital with the suspicion of acute coronary syndrome or present signs and symptoms typical for acute heart failure. Atrial arrhythmias are thought to complicate almost 10% of all TTs cases. The most prevalent among them is atrial fibrillation (AF). Our aim in this study was to systematically evaluate results of observational studies to assess the incidence and prognostic relevance of supraventricular tachyarrhythmias in TTs patients.

Methods: We performed systematic search of the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE databases for research evaluating the incidence and prognostic relevance of atrial fibrillation(AF)/atrial flutter(AFl)/atrial tachycardia(AT) in patients hospitalized due to TTs. Odd ratio (OR) with a 95% confidence interval (CI) was estimated using a random effect model.

Results: 10 studies comprising 4183 patients were included. The incidence of atrial arrhythmias ranged between 7% to 33%. In our research, supraventricular tachyarrhythmias were associated with significant increased risk for all-cause death (OR 2.99; 95% CI: 2.36- 3.80; p < 0.05), intra-hospital mortality (OR 2.46; 95% CI: 1.30 - 4.63; p < 0.05) and long-term mortality (OR 3.01 95% CI: 2.33- 3.90; p < 0.05).

Conclusions: Our meta-analysis suggests that atrial arrhythmias are associated with an elevated risk for short and long-term adverse outcomes in patients with TTs.