Arrhythmias and Conduction Disturbances
Meta-Analysis of Left Ventricular Hypertrophy and Sustained Arrhythmias

https://doi.org/10.1016/j.amjcard.2014.07.015Get rights and content

Highlights

This systematic review and meta-analysis revealed that

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    Patients with left ventricular hypertrophy (LVH) had 3.4-fold greater odds of supraventricular tachycardia.

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    The patients with LVH had 2.8 times greater odds of ventricular tachycardia or fibrillation.

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    Patients with LVH should therefore be risk stratified and followed up closely for earlier detection of these arrhythmias.

Presence of left ventricular hypertrophy (LVH) has been reported to be associated with supraventricular and ventricular arrhythmias, but the association has not been systematically quantified and evaluated. A systematic search of studies in MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases was undertaken through April 2014. Studies reporting on LVH and sustained arrhythmias such as atrial fibrillation and supraventricular tachycardias (SVTs) and ventricular arrhythmias (tachycardia and fibrillation) were identified. Pooled effect estimates were calculated with random-effects models (DerSimonian and Laird). A total of 10 eligible studies with 27,141 patients were included in the analysis. The incidence of SVT in patients with LVH was 11.1% compared with 1.1% among patients without LVH (p <0.001). Patients with LVH had 3.4-fold greater odds of developing SVT (odds ratio 3.39, 95% confidence interval 1.57 to 7.31) than those without LVH, although significant heterogeneity was present (I2 = 98%). Meta-regression analyses revealed the heterogeneity to have originated from differences in the baseline covariates such as age, male gender, hypertension, and diabetes of the individual studies. The incidence of ventricular arrhythmias was 5.5% compared with 1.2% in patients without LVH (p <0.001). The occurrence of ventricular tachycardia or fibrillation was 2.8-fold greater, in the presence of LVH (odds ratio 2.83, 95% confidence interval 1.78 to 4.51), and there was no significant heterogeneity (I2 = 9%). Presence of LVH in hypertensive patients is associated with a greater risk of sustained supraventricular/atrial and ventricular arrhythmias, and there is an unmet need for identifying and refining risk stratification for this group.

Section snippets

Methods

A comprehensive systematic search of studies published from January 1, 1966, to April 1, 2014, was conducted using MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases. Studies reporting on clinically significant sustained arrhythmias such as atrial fibrillation and SVT and ventricular arrhythmias (tachycardia and fibrillation) and LVH were identified. Studies were searched using the following text keywords and search strategy: “left

Results

Our initial search identified 1,025 studies, of which based on our inclusion and exclusion criteria, 10 studies were selected for pooled analysis9, 10, 15, 16, 17, 18, 19, 20, 21, 22 (Figure 1). Characteristics of the 10 selected studies are listed in Table 1. Two studies9, 10 reported data on presence of LVH and SVT and also on LVH and VT and, hence, were considered as 2 separate studies herewith (Table 1). The included studies comprised 27,141 patients, with 9,564 arrhythmia events in total.

Discussion

The findings from this meta-analysis involving 27,141 patients demonstrate an increased risk of supraventricular and ventricular arrhythmias in patients having LVH. The likelihood of having SVT was 3.4-fold greater in patients with LVH, whereas the risk of VT was 2.8-fold greater in patients with LVH. A significant heterogeneity was observed among studies reporting SVT and LVH, but no significant heterogeneity was found in VT and LVH studies. Meta-regression analysis revealed the heterogeneity

Disclosures

The authors have no conflicts of interest to disclose.

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