AB0868 PREVALENCE AND RISK FOR BUNDLE BRANCH BLOCK, ATRIOVENTRICULAR BLOCK AND PACEMAKER IMPLANTATION IN SPONDYLOARTHRITIS. A SYSTEMATIC REVIEW OF THE LITERATURE

Background

Inflammation of the valve attachment site may produce tissue degeneration near the atrioventricular node, which may lead to electrical conduction disturbances, that is to say atrioventricular block (AVB) and bundle branch block (BBB).

Objectives

To evaluate the evidence regarding the prevalence and risk of BB, AVB and pacemaker implantation (PMI) in patients with spondyloarthritis (SpA) compared to a control group without SpA.

Methods

A systematic review of the literature was performed using Pubmed (Medline), EMBASE (Elsevier) and Cochrane Library (Wiley) databases until December 2021. The risk for AVB, BBB and PMI were analyzed. Cohort, case control and cross-sectional studies in patients ≥18 years meeting the classification criteria for SpA were included. The Odds ratio (OR), risk ratio (RR) or Hazard ratio (HR) were considered as outcomes. Data was synthesized in a previously defined extraction form. The risk of bias was assessed by the Newcastle-Ottawa Scale.

Results

In total, eight out of 374 studies were included. As for low grade AVB and BBB, only indirect results comparing prevalences from low to medium quality studies were found. According to population based registries, the sex and age adjusted HR of AVB was 2.3 (95% CI 1.6 - 3.3) in ankylosing spondylitis, 2.9 (95% CI 1.8 - 4.7) in undifferentiated spondyloarthritis and 1.5 (95% CI 1.1 a 1.9) in psoriatic arthritis. The RR for PMI was 1.3 (95% CI 1.16 - 1.46) for groups aged between 65-69 years, 1.33 (95% CI 1.22 - 1.44) for 70-75 years, 1.24 (95% CI 1.55 - 1.33) for 75-79 years and 1.11 (95% CI 1.06 - 1.17) for groups older than 80 years.

AuthorStudy designPopulationSample numberTestOutcomesAdjustmentBaniaamam 2021[6]Cross sectionalAS and osteoarthritis between 50-75 years267ECGPrevalence of AVB, BBB and PMIControls matched for age, sex and smoking statusBengtsson 2017[12]CohortAS, uSpA, PsA, GPfrom the Swedish national registry294136ICD-10Prevalence, Incidence, HR, for AVB and PMI compared to GPAge, sexDik 2010[9]Cross sectionalAS131ECGPrevalence of AVB and BBB Association of PR interval with AS disease related variablesAge, sex, disease durationFeld 2008[10]Case controlPsA compared to non psoriatic nor arthritic patients184ECGPrevalence of AVB, BBB Correlation of PR interval with AS disease related variablesNoneFu 2016[8]Cross sectionalAS between 18-50y without cardiac disease122ECGPrevalence of AVB, BBB AS without kyphosisNoneGoulenok 2010[13]Cross sectionalSpA, RA and control group without known CV disease288ECGPrevalence AVB, BBNoneWard 2018[7]CohortAS from Medicare database older than 6542,327ICD-9Prevalence, incidence, OR of PMIAge, sex, raceYildrir 1999[11]Case controlAS88Holter and ECGPrevalence of AVBNone

Conclusion

The differences of prevalence in AVB and BBB were similar in SpA and control groups even though studies lacked the power. According to population registries there was an two fold-increased risk of high grade AVB in SpA patients. RR for PMI was higher in younger age groups.

Disclosure of Interests

Hye Sang Park: None declared, Ana Laiz Speakers bureau: A.L. has received speaker fees/honoraria from Abbvie, Lilly, Novartis, Pfizer and UCB, Petra Díaz del Campo Fontecha: None declared, Mª Auxiliadora Martín Martínez: None declared, Mercedes Guerra-Rodriguez: None declared, Concepción Alonso Martín: None declared, Jesus Sanchez-Vega: None declared, Hector Corominas Speakers bureau: H.C. has received speaker fees/honoraria from BMS, Gebro, MSD, Lilly, Novartis, Pfizer, Roche, Sanofi, and UCB, Consultant of: H.C. has participated in consulting for Abbvie, Amgen, Biogen, Celgene, Gilead, Kern, Pfizer and Sanofi.

Prevalence and Risk for Bundle Branch Block, Atrioventricular Block and Pacemaker Implantation in Spondyloarthritis. A Systematic Review of the Literature

Objective

To evaluate the evidence regarding the prevalence and risk of bundle branch block (BBB), atrioventricular block (AVB) and pacemaker implantation (PMI) in patients with spondyloarthritis compared to a control group without spondyloarthritis.

Methods

A systematic review of the literature was performed using Pubmed (Medline), EMBASE (Elsevier) and Cochrane Library (Wiley) databases until December 2021. The prevalence and risk for AVB, BBB and PMI were analyzed. Cohort, case control and cross-sectional studies in patients ≥18 years meeting the classification criteria for spondyloarthritis were included. The Odds ratio (OR), risk ratio (RR), or Hazard ratio (HR) and prevalence difference were considered as outcomes. Data was synthesized in a previously defined extraction form which included a risk of bias assessment using the Newcastle-Ottawa Scale.

Results

In total, eight out of 374 studies were included. None of the studies provided results regarding the risk of low grade AVB and BBB in SpA patients. Only indirect results comparing prevalences from low to medium quality studies were found. According to population based registries, the sex and age adjusted HR of AVB was 2.3 (95% CI 1.6–3.3) in ankylosing spondylitis, 2.9 (95% CI 1.8–4.7) in undifferentiated spondyloarthritis and 1.5 (95% CI 1.1 a 1.9) in psoriatic arthritis. The absolute risk for AVB was 0.4% (moderate to high; 95% CI 0.34%-0.69%) for AS, 0.33% (moderate to high; 95% CI 0.21%-0.53%) for uSpA and 0.34% (moderate to high; 95% CI 0.26%-0.45%) for PsA.The RR for PMI in AS patients was 1.3 (95% CI 1.16–1.46) for groups aged between 65 and 69 years, 1.33 (95% CI 1.22–1.44) for 70–75 years, 1.24 (95% CI 1.55–1.33) for 75–79 years and 1.11 (95% CI 1.06–1.17) for groups older than 80 years. The absolute risk for PMI in AS patients was 0.7% (moderate to high risk; 95% CI 0.6–0.8%) for groups aged between 65–69, 1.44% (high risk; 95% CI 1.33–1.6%) for 70–75 years, 2.09% (high risk; 95% CI 2.0–2.2%) for 75–79 years and 4.15% (high risk; 95% CI 4.0–4.3%) for groups older than 80 years

Conclusions

Very few cases of low grade AVB and BBB were observed in observational studies. No study evaluated association measures for low grade AVB and BBB but the differences of prevalence were similar in SpA and control groups even though studies lacked the power to detect statistical differences. According to population based registries there was an approximately two fold-increased risk of high grade AVB in SpA patients. RR for PMI was higher in younger age groups.