Published online Jun 14, 2019. doi: 10.3748/wjg.v25.i22.2788
Peer-review started: February 6, 2019
First decision: February 21, 2019
Revised: April 22, 2019
Accepted: April 29, 2019
Article in press: April 29, 2019
Published online: June 14, 2019
Processing time: 134 Days and 10.5 Hours
Inflammatory bowel disease (IBD), a chronic inflammatory disease of the gastrointestinal tract, could play a role in the pathophysiology of atrial fibrillation (AF).
To investigate the association between IBD and AF development.
We performed a population-based cohort study using records in the Korean National Health Insurance Services database between 2010 and 2014. A total of 37696 patients with IBD (12349 with Crohn’s disease and 25397 with ulcerative colitis) were identified. The incidence rate of newly diagnosed AF in patients with IBD was compared with that in a 3 times larger cohort of 113088 age- and sex-matched controls without IBD.
During 4.9 ± 1.3 years of follow-up, 1120 patients newly diagnosed with AF (348 in the IBD group and 772 in controls) were identified. After adjustments using multivariable Cox proportional hazards, patients with IBD were at a 36% [95% confidence interval (CI) 20%-54%] higher risk of AF than controls. The association between IBD and the development of AF was stronger in younger than in older patients. Patients without cardiovascular risk factors showed a higher risk of AF primarily. Additionally, patients receiving immun-omodulators [Hazard ration (HR) 1.46, 95%CI 1.31-1.89], systemic corticosteroids (HR 1.37, 95%CI 1.10-1.71), or biologics agents (HR 2.38, 95%CI 1.51-3.75) were at higher risk of AF than patients without them.
IBD significantly increased the risk of AF, and the impact of IBD on developing AF was in patients with moderate to severe disease.
Core tip: Inflammatory bowel disease (IBD), a chronic inflammatory disease of the gastrointestinal tract, was strongly associated with an increased risk of atrial fibrillation (AF). Both Crohn’s disease (CD) and ulcerative colitis (UC) increase the risk of AF, with a higher risk in patients with CD than UC. And the impact of IBD on developing AF was stronger in patients receiving immunomodulators, systemic corticosteroids or biologics agents, which are prescribed for moderate-to-severe disease than patients without them. Therefore, physicians need to consider screening for AF in patients with IBD, particularly those who use more potent therapies.