Effect of sarcopenia on risk of atrial fibrillation: a systematic review and meta-analysis of observational studies

Background The association between sarcopenia and risk of atrial fibrillation (AF) remains uncertain. In this study, we aimed to quantify the association between sarcopenia and the risk of AF through a meta-analysis of observational cohort studies. Methods PubMed, Web of Science, EMBASE, and major scientific conference sessions were searched without language restrictions from inception to 15 August 2025. Bibliographies of relevant articles were also manually searched. Observational studies that evaluated the association between sole or combined components of sarcopenia criteria and risk of AF were included. Results Ten studies involving 7,358,442 participants were included in the meta-analysis. Sarcopenia was significantly associated with an increased risk of AF onset [pooled hazard ratio (HR) = 1.44, 95% CI: 1.22–1.68], with high heterogeneity among studies ( I 2 = 93.5%, P < 0.001) but no indication of publication bias (Begg's P = 0.728 and Egger's P = 0278). This association remained significant by sole or concurrent presence of low muscle mass and impaired muscle function, with HR of 1.26 (95% CI: 1.05–1.50) for only impaired muscle function used and HR of 1.79 (95% CI: 1.49–2.15) for comprehensive criteria with two combined components. Subgroup analyses showed that the risk of AF did not appreciably change across sex, age (<60 and ≥60 years), body mass index (BMI) status (non-obese or obese), physical activity (yes or no), duration of follow-up (≥10 or <10 years), and geography (Asian cohorts or non-Asian cohorts), with HRs ranging from 1.22 in young participants with sarcopenia to 1.97 in women with sarcopenia. Conclusions The results of our study demonstrated that sarcopenia is associated with a 44% increased risk of AF onset compared with non-sarcopenia individuals. The association was independent of sex, age, geographic location, duration of follow-up, BMI status, and regular physical activity. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251020653 identifier, CRD420251020653.