Unvaccinated people or those beyond the period of efficacy after influenza vaccination (3) Outcomes: the risk of arrhythmia (we did not restrict the type of arrhythmia, including AF, atrial flutter, ventricular fibrillation, ventricular flutter, cardiac arrest) and estimate effects reported as RRs/HRs/ORs with the corresponding 95% CIs or other measures that could be used to compute these values and (4) Types of studies: RCTs or observational studies. Studies were included if they met the following criteria: (a) were designed as randomized controlled trials (RCTs) or observational studies (b) assessed the relationship between influenza vaccination and the risk of arrhythmia and (c) reported estimate effects as adjusted relative risks (RRs)/hazard ratios (HRs)/odds ratios (ORs) with the corresponding 95% confidence intervals (CIs) or other measures that could be used to compute these values.Īccording to the population, intervention, comparison, outcome, and study design (PICOS) framework, the inclusion criteria were as follows: (1) Participants: adults (aged > 18 years) (2) Exposure and comparator: vaccinated vs. ![]() Thus, in the present study, we aimed to (1) clarify the relationship between the flu vaccine and cardiac arrhythmias and (2) further explore the associations of specific types of arrhythmias (e.g., AF and VA) with the flu vaccine. Given this background, it is not clear whether influenza vaccination is associated with reduced cardiac arrhythmias. The European guidelines do not explicitly link the flu vaccine to cardiac arrhythmias. Although the relationship between the influenza vaccine and cardiovascular events is still being investigated, the 2019 European guidelines for the secondary prevention of cardiovascular diseases have included influenza vaccination as a class I, level of evidence B recommendation to prevent cardiovascular diseases in patients with coronary and other atherosclerotic vascular diseases ( 15). Since then, whether the influenza vaccine reduces the risk of arrhythmias has remained unclear: some studies have found a negative association ( 12, 13), whereas other studies have found a positive association ( 14). However, in 2002, the Canadian Adverse Events Following Immunization Surveillance System (CAEFISS) listed AF as one of many adverse events reported following vaccination against influenza ( 11). Consequently, the flu vaccine could be an effective tool in preventing arrhythmias. An increased occurrence of influenza-associated cardiac arrhythmias, including atrial arrhythmia, cardiac conduction system abnormalities, ventricular arrhythmia (VA), and atrioventricular block, has been reported in previous studies ( 7– 10). ![]() It has been estimated that ∼3–11% of individuals in the United States have symptomatic influenza each year, with an average incidence of 5.1% in adults and 8.7% in children ( 6). ![]() Among these viruses, influenza virus infection has a high incidence. Various infections, either by bacteria or viruses, can cause cardiac injury and secondary dysfunction of the cardiac conduction system ( 1– 5). Cardiac arrhythmias, including atrial fibrillation (AF), atrial flutter, ventricular flutter, ventricular fibrillation, and heart arrest, are a common kind of cardiovascular disease, resulting in frequent hospitalizations, hemodynamic abnormalities, and thromboembolic events.
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