Prevalence and Types of ECG Abnormalities in Rheumatoid Arthritis Patients Without Clinically Evident Cardiovascular Disease at Kenyatta National Hospital

Abstract

Background: Cardiovascular disease (CVD) is one of the extra articular manifestations of RA and one of the leading cause of death in these patients. All layers of the heart may be involved in RA patients with pericarditis being the most common form of cardiac involvement. Routine electrocardiograms can help detect cardiac abnormalities earlier in RA patients leading to appropriate management being instituted early thus causing a reduction in adverse outcomes including mortality. Objective: The primary objective of this study was to describe the prevalence and types of resting ECG abnormalities in RA patients attending KNH rheumatology clinic. Study design and setting: A cross sectional descriptive study done at KNH rheumatology clinic over a period of 3 months from 9/8/2022 to31/10/2022. All adults 18 years and above attending KNH rheumatology clinic and fulfilling the ACR EULAR 2010 criteria were the study population. Methods: A consecutive sampling technique was used to recruit 91 patients who satisfied the ACR /EULAR 2010 diagnostic criteria for RA. The Principal investigator performed ECGs on all cases and interpreted them as per ACC/AHA recommendations for standardization and interpretation of ECG. Data was collected via a printed questionnaire, and checked for completeness prior to entry into the Microsoft Excel 2017. Thereafter, the data was exported to the Statistical Package for Social Sciences (SPSS) version 24.0 for analysis. Results: The study included 91 patients (71 females and 20males) with rheumatoid arthritis without evident cardiovascular disease. The mean age was 44.3 years. The mean disease duration was 10 years and majority of the study population had a moderate disease activity index at 45.6% and 3.3% being in remission. The total prevalence of abnormal of electrocardiographic abnormalities observed in our study population was 29.6%. Electrocardiographic abnormalities found were dominated by left ventricular hypertrophy encountered in 23 patients (25.6%), left atrial enlargement in 16.7% of cases, 8.9% of patients had left axis deviation. Atrial fibrillation was present in 4.4% of the study population with AV block being present in 4% of the participants. Premature atrial contractions were present in 3.3% of the participants and premature ventricular contractions were noted in 2.2% of the study population. Pathological Q waves were seen in 7.8% of the patients. Conclusion: This study highlights the need for systematic electrocardiogram in patients with rheumatoid arthritis, even in the early stages of the disease when cardiovascular involvement is clinically silent because electrocardiographic abnormalities are prevalent in RA patients