Arrhythmias in Dengue: A Systematic Review and Meta-Analysis.

BACKGROUND

Cardiac involvement in dengue has been increasingly recognized, yet the true burden and spectrum of arrhythmias remain uncertain due to heterogeneous and fragmented evidence. We conducted a systematic review and meta-analysis to estimate the proportion of cardiac arrhythmias in patients with dengue and to describe the distribution of major arrhythmia subtypes.

METHODS

We searched PubMed/MEDLINE, EMBASE, LILACS, Global Index Medicus, and Google Scholar from inception to November 2025 without language restrictions. Observational studies reporting the number of dengue patients evaluated for arrhythmias and the number with at least one rhythm disturbance were included. Random-effects generalized linear mixed models with a logit transformation were used to estimate pooled proportion with 95% confidence intervals (CIs). Subgroup analyses were performed by age group. Risk of bias was assessed using the Joanna Briggs Institute tool, and certainty of evidence was evaluated with GRADE.

RESULTS

Thirty-five studies, including 6948 patients, were analyzed. The pooled proportion of any arrhythmia was 24.48% (95% CI 17.54-33.07), with a higher proportion in adults (30.00%) than in children (10.73%). Sinus bradycardia (11.84%) and sinus tachycardia (10.63%) were the most frequent abnormalities. Atrioventricular block was uncommon (1.33%). Between-study heterogeneity was high for most outcomes. No significant small-study effects were detected.

CONCLUSIONS

Cardiac arrhythmias occur in approximately one in four patients with dengue, predominantly as sinus rate abnormalities. While often transient, these findings support the role of baseline and risk-based ECG monitoring, particularly in hospitalized adults and patients with severe disease.