Arrhythmic risk in axial spondyloarthritis: a narrative review

Axial spondyloarthritis (axSpA) is a chronic systemic inflammatory disorder affecting the axial skeleton and potentially the peripheral joints as well as extraskeletal tissues. Chronic systemic inflammation is also known to play a major role in the pathogenesis of conduction disturbances and arrhythmias, through chronic fibrotic scarring and cytokine-mediated delay of atrioventricular (AV) conduction as well as atrial remodelling. More specifically, the prevalence of AV block appears to be high, resulting in an increased risk for pacemaker implantation. Furthermore, axSpA is associated with an increased prevalence of atrial fibrillation, even when adjusting for other cardiovascular risk predictors. As the development of arrhythmia in axSpA appears to be associated with disease activity, controlling the systemic inflammation could potentially offer a viable addition to conventional antiarrhythmic treatment. However, the possible proarrhythmic effects of conventional and newer anti-inflammatory drugs in patients with axSpA need to be further elucidated in the future.