Arrhythmia and Cardiovascular Risks in Inflammatory Bowel Disease: Insights into Disease and Therapy Effects

Abstract

Background and Purpose: Inflammatory bowel disease (IBD), encompassing Crohn’s disease and ulcerative colitis, is increasingly recognized as a systemic inflammatory condition with effects extending beyond the gastrointestinal tract. Emerging evidence indicates that patients with IBD have a heightened risk of developing cardiac arrhythmias, including atrial fibrillation and atrioventricular conduction abnormalities. This review aims to synthesize current epidemiological, mechanistic, and pharmacologic evidence regarding the association between IBD and arrhythmia risk, with particular attention to the role of inflammation and therapeutic agents.

Methods: A comprehensive literature search was conducted in PubMed/MEDLINE, SCOPUS, Embase, and Google Scholar following PRISMA guidelines. The search strategy included MeSH and free-text terms related to “Inflammatory Bowel Disease,” “Crohn’s Disease,” “Ulcerative Colitis,” “Arrhythmia,” and specific treatment classes. Studies published in English between 2000 and 2025 were screened. Eligible studies included original research reporting quantitative risk estimates for arrhythmias in IBD patients or evaluating arrhythmogenic effects of IBD therapies. Methodological quality was assessed using the Newcastle-Ottawa Scale.

Results: Out of 380 identified records, 11 studies met inclusion criteria. Across cohort and genetic studies, IBD was consistently associated with an increased incidence of atrial fibrillation and other conduction disorders, independent of conventional cardiovascular risk factors. Mechanistically, systemic cytokine activation, autonomic imbalance, and myocardial remodeling were recurrently implicated. Pharmacologic influences varied: 5-aminosalicylates were occasionally linked to reversible myocarditis, corticosteroids demonstrated dose-dependent cardiovascular effects, and biologic agents showed overall cardiac safety.

Conclusions: IBD confers an independent risk for cardiac arrhythmias through both inflammatory and treatment-related mechanisms. Recognizing these associations underscores the need for comprehensive cardiovascular assessment and proactive management in IBD care. Multidisciplinary collaboration and longitudinal research are essential to refine risk prediction and optimize outcomes in this growing patient population.