Long-term risk of arrhythmias increased in patients with inflammatory bowel disease

1. This cohort study found that compared to reference-matched individuals with put inflammatory bowel disease (IBD), any type of IBD increased 10-year and 25-year risk for arrhythmias including arrival flutter/fibrillation, other supraventricular arrhythmias, and ventricular arrhythmias/cardiac arrest. 

2. Ulcerative colitis (UC) or unclassified IBD (U-IBD) patients, when matched to their own IBD-free siblings, were more likely to develop atrial fibrillation/flutter, whereas those with Crohn’s disease (CD) were more likely to develop supraventricular arrhythmias and ventricular arrhythmias/cardiac arrest than CD-free siblings. 

Evidence Rating Level: 2 (Good)

Inflammatory bowel disease (IBD) affects millions worldwide and increases one’s risk for a variety of other health conditions long-term. One such condition that has been elucidated in the literature is cardiovascular disease. However, there is limited research on IBD’s possible association with increased risk for arrhythmias (with the exception of atrial fibrillation). This population-based sibling-controlled cohort study in Sweden analyzed patients with biopsy-confirmed IBD (either ulcerative colitis (UC), Crohn’s disease (CD), or unclassified IBD (IBD-U); N = 83,877) as well as reference-matched individuals and their IBD-free siblings. At a median follow-up of 10 years, results did indicate an increased incidence of any type of arrhythmia (aHRCD of 1.15 (95% CI [1.09, 1.21], P < 0.001); aHRUC of 1.14 (95% CI [1.10, 1.18], P < 0.001); aHRU-IBD 1.30 (95% CI [1.20, 1.41], P < 0.001). At 10 years post-IBD diagnosis, there was one extra arrhythmia per 208 Crohn’s or ulcerative colitis patient, and one extra arrhythmia per 81 patients with unclassified IBD compared to reference-matched individuals. The differences in arrhythmia incidence between IBD and non-IBD references continued at 25-year follow-up. More specifically, patients with all types of IBD (CD, UC, and U-IBD) were at increased risk for developing atrial flutter/fibrillation (aHRs = 1.12, 1.12, and 1.13, respectively;  ps < .05), other supraventricular arrhythmias (aHRs = 1.35, 1.31, and 1.34, respectively;  ps < .05), and ventricular arrhythmias/cardiac arrest (aHRs = 1.24, 1.25, and 1.39, respectively;  ps < .05). However, there was no significant association between any types of IBD and bradyarrhythmias. Compared to their IBD-free siblings, patients with UC or U-IBD were more likely to develop overall arrhythmias (aHRUC 1.18 (95% CI [1.09, 1.28], P < 0.001); aHRU-IBD 1.19 (95% CI [0.99, 1.42], P = .058) and atrial flutter/fibrillation (aHRUC 1.19 (95% CI [1.09, 1.30], P < 0.001); aHRU-IBD 1.24 (95% CI [1.01, 1.53], P = .044). Those with CD were at increased risk of supraventricular arrhythmias and ventricular arrhythmias/cardiac arrest (aHRCD 1.39 and 1.27, respectively; ps < .05). A lack of data quantifying arrhythmia risk relative to IBD severity should be recognized; whether individuals with more frequent IBD flares and more severe symptoms are at an even higher increased risk is unknown based on these results. However, the overall results of this study should raise awareness for health professionals to the potential increased risk of several types of arrhythmias with IBD. 

Click to read the study in PLOSONE

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