Background: Previous studies have suggested that there is an increased incidence of atrial fibrillation (AF) in ivabradine treated patients. Recent large scale randomized control trial (RCT) have nearly doubled the population to assess this association.
Methods: Major databases were searched through May 2015. We included RCTs comparing ivabradine and placebo with the development of AF reported. We used random-effects models to calculate relative risks (RR) and confidence intervals (CI) using standard meta-analytical techniques.

Results: We included 7 RCTs published from 2008 to 2015 involving 36,622 patients. There was a significantly higher incidence of AF in the ivabradine group compared to placebo (4.2% vs. 3.4%, RR 1.24 (CI 1.08-1.43), p < 0.002.There was no evidence of significant heterogeneity (I2=21.7%, p=0.26) or publication bias (p=0.89) noted. One patient developed AF for every 127 patients taking the medication.
Conclusions: This meta-analysis of 7 RCTs have found a significantly higher incidence of AF with the use of ivabradine. Futher data analysis may be warranted to identify subgroups at higher arrhythmic risk.