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 ventricular hypertrophy” OR “hypertensive cardiomyopathy” OR “concentric cardiomyopathy,” “LVH” AND “arrhythmia,” OR “supraventricular arrhythmia” OR “ventricular arrhythmia” OR “ventricular tachycardia,” OR “ventricular fibrillation” OR “atrial fibrillation” OR “atrial flutter” OR “atrial tachycardia” OR “atrio-ventricular re-entrant tachycardia” OR “atrio-ventricular nodal re-entrant tachycardia” OR “supraventricular tachycardia.” A manual search of reference lists of appropriate review articles and original retrieved studies was also performed to identify studies potentially missed by the database searches. We did not impose any restrictions on language for the search.

Two physician-reviewers (SC and PS) independently reviewed originally identified titles and abstracts and selected studies for pooled analysis based on the study criteria. We selected studies that reported incidence and/or prevalence of SVT or VT in patients with and without LVH. Studies that reported data on presence of LVH and SVT, and LVH and VT both, were considered as 2 separate studies. Studies involving patients with hypertrophic cardiomyopathy were not included. We considered only high-grade arrhythmias, and studies reporting simple atrial or ventricular ectopy were not included. Only original articles were considered for this meta-analysis; reviews, letters to editors without original data, case reports, case series, and conference abstracts without peer-reviewed publication were excluded.

Two reviewers independently extracted data from all selected studies. The following data were extracted from each study: first author’s name, year of publication, mean age, gender distribution, prevalence of hypertension, LVH criteria, and incidence and/or prevalence of SVT or VT in patients with and without LVH. For studies that published data on LVH regression and arrhythmia, arrhythmia data after regression were collected to account for treatment changes when available. The quality of each study was assessed using the strengthening Meta-analysis of Observational Studies in Epidemiology (MOOSE) checklist and ratified with the Newcastle-Ottawa scale ( Supplementary Data ).

The meta-analysis was performed in accordance with the recommendations from the Cochrane Collaboration and the MOOSE statement. Pooled effect estimates were calculated with random-effects models (DerSimonian and Laird) because of known clinical and methodological heterogeneity of the studies. Heterogeneity was assessed using Higgins and Thompson I ² statistic, with I ² <25% considered low. In addition, in presence of heterogeneity, meta-regression was used to evaluate the modifying effect of common clinical and demographic variables, including age, gender, hypertension, and diabetes. Publication bias was estimated using funnel plots and the Egger regression test. A 2-tailed p <0.05 was considered statistically significant. All analyses were performed using Stata 11 (Stata Corp., College Station, Texas) and RevMan v5.02 (Nordic Cochrane Center, Copenhagen, Denmark).

Results

Our initial search identified 1,025 studies, of which based on our inclusion and exclusion criteria, 10 studies were selected for pooled analysis ( Figure 1 ). Characteristics of the 10 selected studies are listed in Table 1 . Two studies 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. Of selected studies, 7 studies involving 21,606 patients reported data on SVT, of which 5 studies reported data on atrial fibrillation and LVH. Six studies with 5,535 patients reported data on LVH and VT. The incidence of SVT in patients with LVH was 11.1% compared with 1.1% among patients without LVH (p <0.001). There was a 3.4-fold greater odds of detecting supraventricular arrhythmias in association with presence of LVH (odds ratio 3.39, 95% confidence interval 1.57 to 7.31), although significant heterogeneity was present (I ² = 98%; Figure 2 ). 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 (residual I ² = 0%). The incidence of ventricular arrhythmias was 5.5% compared with 1.2% in patients without LVH (p <0.001). There was a 2.8-fold greater odds of detecting clinically significant ventricular arrhythmias, in the form of ventricular tachycardia or fibrillation, in association with the presence of LVH (odds ratio 2.83, 95% confidence interval 1.78 to 4.51), no significant heterogeneity being present (I ² = 9%; Figure 3 ).

Search strategy according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist.

Table 1

Key features of included articles

First Author (R)	Year	Patients	Age (Years)	Male (%)	Hypertension (%)	LVH Criteria	Arrhythmia	Number Patients With Arrhythmia in
								LVH	Non LVH
Aronow	1999	2,384	81 ± 9	35	NR	ECHO	AF	201/1,024	112/1,360
Bender	2012	317	67 ± 12	82	NR	EKG	VT	31/109	33/208
Cea-Calvo	2007	7,108	72 ± 7	46	73	EKG	AF	183/886	423/6,222
Hennersdorf	2007	104	63 ± 11	59	100	ECHO	SVT	12/47	5/56
Hennersdorf	2007	104	63 ± 11	59	100	ECHO	VT	2/47	1/56
Levy	1987	4,960	58	45	NR	EKG/ECHO	VT	6/843	12/3,994
Martin-Rioboo	2009	570	65 ± 11	46	60	EKG	AF	24/78	5/492
McLenachan	1987	150	58 ± 2	66	67	EKG	VT	14/50	5/100
Novo	1997	128	52 ± 9	68	100	ECHO	SVT	18/66	8/62
Novo	1997	128	52 ± 9	68	100	ECHO	VT	8/66	2/62
Okin	2006	8,861	67 ∗	45	100	EKG	AF	411/5,924	290/2,907
Verdecchia	2003	2,482	51 ± 12	53	100	EKG	AF	85/424	144/2,058

AF = atrial fibrillation; ECHO = 2-dimensional echocardiography; EKG = electrocardiogram; LVH = left ventricular hypertrophy; NR = not reported; R = reference number; SVT = supraventricular tachycardia; VT = ventricular tachycardia.

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