S1474 Association Between Biologic Therapy and Incidence of Cardiac Arrhythmias in Patients With Inflammatory Bowel Disease: A Propensity Score-Matched Cohort Analysis Using Real-World Data

Introduction: Inflammatory bowel disease (IBD) has been increasingly recognized as a risk factor for cardiac arrhythmias. Recent studies have shown that the biologic therapy used for treatment of IBD can have a potential protective effect against fatal cardiovascular outcomes including arrhythmias. However, the data is limited. We conducted a comparative analysis between IBD patients with vs without biologic treatment on the incidence and burden of cardiac arrhythmias. Methods: This retrospective cohort study utilized electronic health records from the TriNetX Research USA network. IBD was defined using International Classification of Diseases-10 codes for Crohn’s disease and ulcerative colitis. We identified 2 IBD patient cohorts: those exposed to biologic therapy (n = 101,711) and those not receiving biologics (n = 486,879). One-to-one propensity score matching (PSM) was performed based on demographics and clinical variables to balance baseline characteristics. Patients with arrhythmias prior to the index event were excluded. Outcomes included atrial fibrillation, AF (I48), supraventricular tachycardia, SVT (I47–I49), bradyarrhythmias (I44–R00), and other arrhythmias (I45–I49), assessed using risk difference, odds ratios (OR), Kaplan-Meier survival, and event frequency analyses. Results: After propensity score matching, the cohorts were well-balanced (n = 98,543 each). The biologics-treated IBD cohort had significantly reduced risk of AF (2.7% vs 4.3%; OR 0.619, 95% CI: 0.594–0.645, P < 0.001), SVT (2.2% vs 3.0%; OR 0.742, 95% CI: 0.710–0.777, P < 0.001), bradyarrhythmias (3.7% vs 5.1%; OR 0.703, 95% CI: 0.678–0.728, P < 0.001), and other arrhythmias (5.3% vs 6.8%; OR 0.766, 95% CI: 0.743–0.790, P < 0.001). Kaplan-Meier analysis showed higher arrhythmia-free survival in the biologics cohort across all arrhythmia subtypes (P < 0.001). The number of arrhythmia events was also lower in the biologics group for AF (mean 10.9 vs 12.2, P = 0.016) and bradyarrhythmias (2.6 vs 2.8, P = 0.025). Conclusion: Our large-scale real-world study shows that biologics were associated with significant reduction in the incidence of arrhythmias in IBD patients. This may be explained by the potential of the biologics to inhibit the systemic inflammatory cascade responsible for triggering the arrhythmias through electrical dysregulation, structural remodeling, and changes in the central and peripheral sympathetic outflows. Future prospective studies should investigate class-specific effects of biologics and validate the cardioprotective effect in IBD patients.