Atrial fibrillation and breast cancer-Vicious twins? A systematic review and meta-analysis

Xiongda Yao; Qingwen Hu; Xiao Liu; Qing Ling; Yurong Leng; Huilei Zhao; Peng Yu; Jianyong Ma; Yujie Zhao; Menglu Liu; Renqiang Yang

doi:10.3389/fcvm.2023.1113231

Atrial fibrillation and breast cancer-Vicious twins? A systematic review and meta-analysis

Front Cardiovasc Med. 2023 Mar 10:10:1113231. doi: 10.3389/fcvm.2023.1113231. eCollection 2023.

Authors

Xiongda Yao¹, Qingwen Hu¹, Xiao Liu^{2

3}, Qing Ling¹, Yurong Leng⁴, Huilei Zhao⁵, Peng Yu⁶, Jianyong Ma⁷, Yujie Zhao⁸, Menglu Liu⁸, Renqiang Yang¹

Affiliations

¹ Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
² Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
³ Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, Guangdong, China.
⁴ The Affiliated Stomatological Hospital of Nanchang University, Nanchang, Jiangxi, China.
⁵ Department of Anesthesiology, The Third Hospital of Nanchang, Nanchang, Jiangxi, China.
⁶ Department of Endocrine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
⁷ Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
⁸ Department of Cardiology, Seventh People's Hospital of Zhengzhou, Zhengzhou, Henan, China.

Abstract

Background: Epidemiological studies suggest a bidirectional association between atrial fibrillation and breast cancer. This study aimed to conduct a meta-analysis to elucidate the prevalence of atrial fibrillation among breast cancer patients, and the bidirectional association between atrial fibrillation and breast cancer.

Methods: PubMed, the Cochrane Library, and Embase were searched to identify studies reporting the prevalence, incidence, and bidirectional association between atrial fibrillation and breast cancer. The study was registered with PROSPERO (CRD42022313251). Levels of evidence and recommendations were assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results: Twenty-three studies (17 retrospective cohort studies, 5 case-control studies and 1 cross-sectional study) involving 8,537,551 participants were included. Among patients with breast cancer, the prevalence of atrial fibrillation was 3% (11 studies; 95% CI: 0.6 to 7.1%) and the incidence was 2.7% (6 studies; 95% CI: 1.1 to 4.9%). Breast cancer was associated with increased risk of atrial fibrillation (5 studies; hazard ratio [HR]: 1.43, 95% CI: 1.12 to 1.82, I² = 98%). Atrial fibrillation was also significantly associated elevated risk of breast cancer (5 studies HR: 1.18, 95% CI: 1.14 to 1.22, I² = 0%). Grade assessment shown low certainty of the evidence for the risk of atrial fibrillation and moderate certainty of the evidence for the risk of breast cancer.

Conclusion: Atrial fibrillation is not uncommon in patients with breast cancer and vice versa. There is a bidirectional association between atrial fibrillation (low certainty) and breast cancer (moderate certainty).

Keywords: association; atrial fibrillation; breast cancer; incidence; prevalence.

Grants and funding

This work was supported by the National Natural Science Foundation of China (No. 81960081), the Jiangxi Thousand Talents Plan Project (No. jxsq2019201029), and the 5511 Science and Technology Innovation Talent Program of Jiangxi (No. 20171BCB18004). The source of funding did not have any impact on study design; collection, analysis, and interpretation of data or writing of the manuscript.