Title:Ankylosing Spondylitis and Risk of Cardiac Arrhythmia and Conduction Disorders: A Systematic Review and Meta-analysis

VOLUME: 17 ISSUE: 5

Author(s):Negar Morovatdar, Gerald F. Watts, Yones Bondarsahebi, Fatemeh Goldani, Elham Rahmanipour, Ramin Rezaee and Amirhossein Sahebkar*

Affiliation:Clinical Research Development Unit, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital, School of Medicine, University of Western Australia, Perth, Western Australia, Students Research Committee, Faculty of Medicine, Mashhad University of medical sciences, Mashhad, Evidence Based Medicine Research Group, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Evidence Based Medicine Research Group, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Clinical Research Development Unit, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad

Keywords:Ankylosing spondylitis, rheumatology, cardiovascular disease, arrhythmia, systematic review, meta-analysis.

Abstract: Objective: The objective of this study isto assess the association between ankylosing spondylitis (AS) and risk of heart conduction disorders and arrhythmia.

Methods: PubMed, Embase, and Web of Science databases were systematically searched for observational studies that investigated the association between AS and risk of heart conduction disorders and arrhythmia with no language or date restrictions until September 16, 2019. We used randomand fixed-effects models to pool the results of the studies. Publication bias was assessed by Egger’s test. Subgroup analysis was carried out based on the study design. A p-value less than 0.05 was considered significant. Comprehensive Meta-Analysis (CMA) software was used to perform meta-analysis. Results: After removing duplicates, we reviewed 135 articles. Finally, we included seven articles in our meta-analysis, of which four studies reported AV block and any conductive abnormality and three focused on atrial fibrillation and any arrhythmia. Based on our meta-analysis, an increased risk of atrial fibrillation (RR: 1.85, 95%CI: 1.15-2.98) and atrioventricular block (OR: 3.46, 95%- CI: 1.09-10.93) was found in AS subjects compared to the general population. In a subgroup analysis based on study design, we found a greater association between AS and atrioventricular block in cohort studies (RR: 5.14, 95%CI: 1.001-26.50) compared to cross-sectional ones. However, we did not find any association between AS and any arrhythmia (OR=3.36, 95% CI: 0.93-12.15), or conduction disorders (OR: 0.64, 95%CI: 0.38-1.06). No publication bias was found. Conclusion: Our results support an association between AS and a higher risk of atrial fibrillation and atrioventricular block.