Arrhythmic risk stratification in psoriatic arthritis: a retrospective, electrogram-based comparative analysis

Psoriatic arthritis (PsA) is a chronic inflammatory systemic disease that is associated with cardiovascular comorbidities, particularly with an increased risk of arrhythmias. Despite the evidence, a structured population-based risk stratification that relates ECG parameters to clinical characteristics in PsA is still lacking.

Data from patients diagnosed with PsA who presented to our centre between 2014 and 2022 as well as from an age-matched and sex-matched control group of cardiovascular patients were collected. A variety of established ECG parameters associated with atrial and ventricular repolarisation and atrioventricular conduction as well as a comprehensive set of clinical variables were evaluated.

A total of 725 patients with PsA alongside 725 matched cardiovascular patients were enrolled (mean age 52.5±13.4 years). The median duration of PsA was 2 years. Patients with PsA had similar rates of first-degree atrioventricular block (AVB I°) with the control group (9.5% vs 10.2%; p=0.725). After excluding patients with known atrial arrhythmias, patients with PsA had higher rates of significant P-wave terminal force in V1 versus controls (30.2% vs 14.1%; p<0.001). Furthermore, patients with PsA had a longer corrected Tpeak-Tend interval (0.26±0.04 vs 0.23±0.05; p<0.001). After adjusting for age, among patients with PsA, male sex (16.4% vs 7.1%; p=0.006) as well as long disease duration (18.0% vs 6.9%; p<0.001) were associated with AVB I°.

Patients with PsA are at a significantly increased risk for ECG abnormalities related to both atrial and ventricular repolarisation as well as atrioventricular conduction. Non-invasive, ECG-based tools for structured risk stratification could facilitate the early detection of patients at risk.