Systematic review of the incidence and clinical risk predictors of atrial fibrillation and permanent pacemaker implantation for bradycardia in Fabry disease.

Abstract

INTRODUCTION:

Fabry disease (FD) is an X-linked lysosomal storage disorder caused by enzyme deficiency, leading to glycosphingolipid accumulation. Cardiac accumulation triggers local tissue injury, electrical instability and arrhythmia. Bradyarrhythmia and atrial fibrillation (AF) incidence are reported in up to 16% and 13%, respectively.

OBJECTIVE:

We conducted a systematic review evaluating AF burden and bradycardia requiring permanent pacemaker (PPM) implantation and report any predictive risk factors identified.

METHODS:

We conducted a literature search on studies in adults with FD published from inception to July 2019. Study outcomes included AF or bradycardia requiring therapy. Databases included Embase, Medline, PubMed, Web of Science, CINAHL and Cochrane. The Risk of Bias Agreement tool for Non-Randomised Studies (RoBANS) was utilised to assess bias across key areas.

RESULTS:

11 studies were included, eight providing data on AF incidence or PPM implantation. Weighted estimate of event rates for AF were 12.2% and 10% for PPM. Age was associated with AF (OR 1.05-1.20 per 1-year increase in age) and a risk factor for PPM implantation (composite OR 1.03). Left ventricular hypertrophy (LVH) was associated with AF and PPM implantation.

CONCLUSION:

Evidence supporting AF and bradycardia requiring pacemaker implantation is limited to single-centre studies. Incidence is variable and choice of diagnostic modality plays a role in detection rate. Predictors for AF (age, LVH and atrial dilatation) and PPM (age, LVH and PR/QRS interval) were identified but strength of association was low. Incidence of AF and PPM implantation in FD are variably reported with arrhythmia burden likely much higher than previously thought.

PROSPERO DATABASE:

CRD42019132045.

• Authors: Ravi Vijapurapu, Ashwin Roy, Polyvios Demetriades, Adrian Warfield, Derralynn A Hughes, James Moon, Peter Woolfson, Joseph de Bono, Tarekegn Geberhiwot, Dipak Kotecha, Richard Paul Steeds
• Journal: Open heart (Open Heart) Vol. 10 Issue 2 (07 2023) ISSN: 2053-3624 [Print] England
• PMID: 37460269 (Publication Type: Systematic Review, Journal Article)
• Copyright: © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Topics

• Adult
• Humans
• Bradycardia (diagnosis, epidemiology, etiology)
• Atrial Fibrillation (diagnosis, epidemiology, therapy)
• Fabry Disease (complications, diagnosis, epidemiology)
• Incidence
• Pacemaker, Artificial (adverse effects)