EULAR 2026: Increased Risk of Cardiac Arrhythmias and Conduction Disorders in Autoimmune Diseases

The European Alliance of Associations for Rheumatology (EULAR) 2026 Congress (3 – 6 June 2026, London) added further weight to evidence that systemic autoimmune diseases have important cardiovascular consequences beyond immune dysregulation. A systematic review and meta-analysis presented at the Congress indicated that patients with autoimmune diseases have a significantly higher risk of cardiac arrhythmias and conduction disorders than the general population.

Meta-Analysis: Elevated Risk of Cardiac Arrhythmias and Conduction Disorders Across Autoimmune Diseases

The meta-analysis included 40 studies involving more than 210,000 patients with autoimmune diseases and over 800,000 controls. Eligible studies included adults with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), systemic sclerosis (SSc), Sjögren’s syndrome, vasculitis, or spondyloarthritis, and reported atrial or ventricular arrhythmias, bradyarrhythmias, or conduction abnormalities. Overall, the risk of any arrhythmia was significantly higher in patients with autoimmune diseases, with a pooled hazard ratio (HR) of 1.62 (95 % confidence interval [CI], 1.00–2.64; p < 0.05).1

Disease-specific findings

Systemic Sclerosis

The risk varied substantially across different autoimmune conditions. SSc showed particularly strong associations with a markedly increased risk of both ventricular arrhythmias (HR, 3.86; 95 % CI, 1.92–7.75) and conduction disorders (HR, 2.57; 95 % CI, 1.48–4.45). This is clinically plausible given the vascular injury and fibrosis associated with SSc, which may involve the myocardium and cardiac conduction tissue.1

Rheumatoid Arthritis

In RA, atrial fibrillation was significantly more prevalent than in control populations (15.3% vs 6.0%; p = 0.015). This association was independent of traditional cardiovascular risk factors, supporting a potential contribution of RA–related systemic inflammation to increased arrhythmic risk.1

Ankylosing spondylitis and SLE

Additional findings were reported in ankylosing spondylitis, in which the odds of atrioventricular block were significantly increased compared with controls (odds ratio [OR], 3.46; 95% CI, 1.09–10.93). In SLE, QTc prolongation and ventricular arrhythmias were observed in 9% of the patients. In addition, anti-Ro/SSA seropositivity was associated with increased odds of arrhythmia (OR, 1.44; 95% CI, 1.25–1.66). Collectively, these findings suggest potential value in disease-specific and serology-informed cardiovascular risk stratification.1

Consistent Evidence Despite Heterogeneity

Although the meta-analysis showed moderate heterogeneity (I² = 48%), the direction of effect remained broadly consistent across the autoimmune diseases examined, supporting the overall robustness of the findings. Long-term cohort studies with follow-up exceeding five years further confirmed an increased cumulative risk of complex arrhythmias and pacemaker implantation, reinforcing the need for ongoing cardiovascular surveillance rather than one-off assessment.1

Implications for Practice

Identifying Patients at Increased Cardiovascular Risk

These findings reinforce the growing recognition that systemic autoimmune diseases are associated with cardiovascular complications extending beyond accelerated atherosclerosis and thrombotic events. The observed increase in cardiac arrhythmias and conduction disorders suggests that cardiovascular risk assessment in patients with autoimmune diseases should include consideration of rhythm abnormalities, particularly in those with longstanding disease, high inflammatory burden, or symptoms suggestive of cardiac involvement. The magnitude of risk observed in SSc, RA, ankylosing spondylitis, and selected subgroups of SLE highlights the need for heightened clinical awareness across multiple rheumatic diseases.

Role of Cardiovascular Screening and Surveillance

Routine cardiovascular evaluation may facilitate earlier identification of subclinical arrhythmias and conduction abnormalities. Baseline and periodic electrocardiography (ECG) can be considered in patients with autoimmune diseases, particularly those with known cardiovascular involvement, persistent disease activity, or risk factors for cardiac complications. In patients reporting palpitations, syncope, presyncope, unexplained fatigue, dizziness, or exertional intolerance, ambulatory ECG monitoring, most commonly performed using a Holter Monitor, may provide additional diagnostic value. The findings from long-term cohort studies indicating increased rates of complex arrhythmias and pacemaker implantation further support the importance of ongoing surveillance rather than a single cardiovascular assessment.

Importance of Inflammation Control and Risk Factor Management

The mechanisms linking autoimmune diseases to arrhythmias are likely multifactorial and may include chronic systemic inflammation, autonomic dysfunction, myocardial inflammation, microvascular injury, and fibrosis affecting the cardiac conduction system. Consequently, arrhythmic risk may not be fully explained by traditional cardiovascular risk factors alone. Optimal control of underlying inflammatory disease may therefore represent an important component of cardiovascular risk reduction. In parallel, clinicians should continue to address modifiable cardiovascular risk factors, including hypertension, diabetes, dyslipidaemia, smoking, obesity, and physical inactivity, as part of a comprehensive management strategy.

Multidisciplinary Care and Future Directions

Given the complex interaction between immune-mediated disease and cardiovascular pathology, close collaboration between rheumatologists, cardiologists, and primary care physicians may help improve patient outcomes. Disease-specific patterns of arrhythmic risk, including the association between anti-Ro/SSA positivity and arrhythmias in SLE, also suggest potential opportunities for more personalised risk stratification. Taken together, these findings support a proactive, multidisciplinary approach to cardiovascular monitoring and management in patients with systemic autoimmune diseases, with the aim of detecting clinically significant cardiac involvement before irreversible complications occur.

Reference:

1. Theran Leon JS, et al. Cardiac Arrhythmias and Conduction Disorders in Autoimmune Diseases: A Systematic Review and Meta-Analysis. Presented at EULAR 2026; POS0159.