Data_Sheet_1_Influenza vaccination is associated with a decreased risk of atrial fibrillation: A systematic review and meta-analysis.docx

BackgroundEvidence from longitudinal studies has shown that influenza infection is linked to an increased risk of arrhythmia. Therefore, we aimed to assess the role of influenza vaccination in arrhythmia prevention.
Materials and methodsThe PubMed, Embase, and Cochrane Library databases were searched to identify studies that investigated the potential effects of the influenza vaccine on arrhythmia risk published until October 25th, 2021. The study was registered with PROSPERO (CRD42022300815).
ResultsOne RCT with 2,532 patients and six observational studies with 3,167,445 patients were included. One RCT demonstrated a non-significant benefit of the influenza vaccine against arrhythmias [odds ratio (OR) = 0.43, 95% confidence interval (CI): 0.11–1.64; P = 0.20] in patients after myocardial infarction or those with high-risk stable coronary heart disease. A meta-analysis based on observational studies showed that vaccination was associated with a significantly lower risk of arrhythmia (OR: 0.82, 95% CI: 0.70–0.97; P = 0.02; I2 = 76%). Additionally, subgroup analysis showed a decreased risk of atrial fibrillation (AF) (OR: 0.94, 95% CI: 0.90–0.98; P = 0.006; I2 = 0%) and a non-significant but positive trend concerning ventricular arrhythmias (VAs) (OR: 0.68, 95% CI: 0.42–1.11; P = 0.12; I2 = 85%) after influenza vaccination.
ConclusionBased on the current evidence, influenza vaccination may be associated with a reduced risk of arrhythmia, especially AF. Influenza vaccination may be an effective tool for the prevention of arrhythmias. The effect of influenza vaccination on the risk of VAs and arrhythmias in patients at low risk for cardiovascular diseases should be further studied.
Systematic review registration[https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42022300815].

背景
现有纵向研究证据表明，流感病毒感染与心律失常发病风险升高存在关联。本研究旨在评估流感疫苗接种在心律失常预防中的作用。

材料与方法
检索PubMed、Embase及Cochrane Library数据库，以纳入2021年10月25日前发表的、探讨流感疫苗对心律失常风险潜在影响的相关研究。本研究已在PROSPERO平台完成注册（注册号：CRD42022300815）。

结果
本研究共纳入1项涉及2532名受试者的随机对照试验（Randomized Controlled Trial, RCT），以及6项共计3167445名受试者的观察性研究。1项RCT结果显示，在心肌梗死术后或高危稳定性冠心病患者中，流感疫苗接种对心律失常未表现出显著保护作用[比值比（odds ratio, OR）=0.43，95%置信区间（confidence interval, CI）：0.11~1.64；P=0.20]。基于观察性研究的荟萃分析结果显示，疫苗接种与心律失常风险显著降低相关（OR=0.82，95%CI：0.70~0.97；P=0.02；I²=76%）。此外，亚组分析显示，流感疫苗接种可降低心房颤动（atrial fibrillation, AF）发病风险（OR=0.94，95%CI：0.90~0.98；P=0.006；I²=0%），而对室性心律失常（ventricular arrhythmias, VAs）的保护作用虽未达到统计学显著性，但呈现出潜在的正向趋势（OR=0.68，95%CI：0.42~1.11；P=0.12；I²=85%）。

结论
基于现有证据，流感疫苗接种或可降低心律失常发病风险，尤其是心房颤动。流感疫苗接种或可成为心律失常预防的有效手段。流感疫苗接种对心血管疾病低危人群的室性心律失常及整体心律失常风险的影响，尚需进一步研究明确。

系统综述注册信息
[https://www.crd.york.ac.uk/PROSPERO/]，注册号[CRD42022300815]。