Session Information
Title: Epidemiology and Public Health (ACR): Rheumatoid Arthritis and Systemic Lupus Erythematosus Outcomes
Session Type: Abstract Submissions (ACR)
Background/Purpose
Cardiovascular disease is a major cause of death among systemic lupus erythematosus (SLE) patients. Although the prevalence of atrial fibrillation (0.5-1%) and QT prolongation (7%) is well studied in the general population, little is known regarding arrhythmias in SLE. The aim of this project is to determine the prevalence of arrhythmias in a SLE population.
Methods
We retrospectively reviewed electrocardiograms (ECGs) of SLE patients seen in inpatient, outpatient and emergency department settings over a 10-year time frame at a single academic center. Abnormal ECG findings were confirmed by an electrophysiologist. ECGs were categorized as abnormal if arrhythmias or QT prolongation (QTc ≥460ms for women; ≥450ms for men) were present. Sinus bradycardia, 1st degree AV block, and sinus tachycardia were not considered arrhythmias but were recorded. Arrhythmias were also ascertained through review of ICD9 codes for the subset of SLE patients with available ECGs.
Results
Of 1,139 SLE patients, 235 had available ECGs. 160 were white (68%), 33 black (14%), 27 Asian (12%), and 15 Hispanic (6%). 217 were female (92%), 18 (8%) male, and the average age was 52 ± 15 (average ± SD). Through ECG review, 6% had tachyarrhythmias (3% with atrial fibrillation) and 17% had QT prolongation (Table 1). None had bradyarrhythmias. Through ICD9 code examination, more had tachyarrthythmias (15%), including atrial fibrillation (9%), compared with direct ECG review. 35 of 53 abnormal ECGs (66%) were obtained in the inpatient setting, 11 (21%) in the outpatient setting, and 7 (13%) in the emergency department. The most common ECG indication was chest pain (12% of abnormal and 16% of normal ECGs).
Conclusion
Sinus tachycardia was the most common ECG finding among our SLE patients. Compared to the general population, our SLE patients had a higher prevalence of atrial fibrillation and QT prolongation. This is likely an underestimation of the true arrhythmia prevalence, given that review of ICD9 codes revealed an even higher rate of tachyarrhythmias compared to direct ECG review. As QT prolongation was common in our SLE patients, it is important to be vigilant about drug interactions and the electrophysiologic effects of various medications, such as antibiotics, in these patients. Further prospective study of arrhythmias, their outcomes, and underlying causative factors (such as medication use and disease severity) in SLE patients is warranted.
Table 1. Prevalence of Arrhythmias in SLE patients after Review of ECGs and ICD9 codes
|
Arrhythmia |
Type of Review, N (%) |
|
|
|
ECG, N=235 |
ICD9 Code, N=235
|
|
Tachyarrhythmia |
13 (6) |
35 (15) |
|
Atrial fibrillation |
7 (3) |
21 (9) |
|
Atrial flutter |
2 (1) |
6 (3) |
|
Atrial tachycardia |
2 (1) |
8 (3) |
|
Supraventricular tachycardia |
2 (1) |
3(1) |
|
Paroxysmal ventricular tachycardia |
0 (0) |
8 (3) |
|
QT Prolongation |
40 (17) |
4 (2) |
|
Sinus Tachycardia |
42 (18) |
Not Available |
|
Sinus Bradycardia |
34 (14) |
Not Available |
|
1st Degree AV Block |
6 (3) |
3 (1) |
Disclosure:
G. Myung,
None;
L. J. Forbess,
None;
M. L. Ishimori,
None;
S. Chugh,
None;
D. Wallace,
None;
M. H. Weisman,
None.
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