Adverse Arrhythmia-Related Outcomes After Catheter Ablation in Patients with Inflammatory Bowel Disease: A Nationwide Propensity Score–Matched Cohort Study

Abstract Aim Inflammatory bowel diseases (IBD) have been associated with an increased long-term risk of arrhythmia. However, clinical outcomes following catheter ablation in patients with IBD are unknown. Methods In this nationwide Swiss cohort study of adults undergoing catheter ablation for arrhythmia between 2012 and 2022, patients with IBD were propensity score-matched 1:10 to comparators without IBD. The primary endpoint was a composite of the first occurrence of any of the following events: reablation, cardioversion, or hospitalization for arrhythmia. Secondary endpoints were each individual component of the primary endpoint. An additional win-ratio-based hierarchical analysis was performed. Hazard ratios (HRs) and incidence rates (IRs) were calculated using Cox proportional hazards modeling. Results A total of 251 patients with IBD and 2,429 matched comparators were included in the study. After a median follow-up time of 2.6 years (IQR 0.8-5.6), the primary endpoint occurred in 81 (32.3%, IR:100.8/1,000 person-years) patients with IBD and in 640 (26.3%, IR:73.3/1,000 person-years) matched comparators, yielding an HR of 1.30 (95% confidence interval [CI]=1.03-1.64). Among the individual components of the primary endpoint, hospitalization for arrhythmia was more frequent in patients with IBD (HR 1.29, 95%CI=1.02-1.64), while the remaining components did not differ between groups. In hierarchical win-ratio analysis, patients with IBD had worse composite outcomes than matched comparators (win-ratio 0.80, 95% CI=0.65-0.99, p=0.04). Conclusion Patients with IBD undergoing catheter ablation exhibited 30% higher hazards of adverse arrhythmia-related outcomes.