Anti-Ro/SSA Antibodies and Cardiac Arrhythmias in the Adult: Facts and Hypotheses

Abstract

It is well established that the passive trans‐placental passage of anti‐Ro/SSA antibodies from mother to foetus is associated with the risk to develop an uncommon syndrome named neonatal lupus (NLE), where the congenital heart block represents the most severe clinical feature. Recent evidence demonstrated that also adult heart, classically considered invulnerable to the anti‐Ro/SSA antibodies, may represent a target of the arrhythmogenicity of these autoantibodies. In particular, the prolongation of the QTc interval appears the most frequent abnormality observed in adults with circulating anti‐Ro/SSA antibodies, with some data suggesting an association with an increased risk of ventricular arrhythmias, also life threatening. Moreover, even though the association between anti‐Ro/SSA antibodies and conduction disturbances is undoubtedly less evident in adults than in infants, from the accurate dissection of the literature data the possibility arises that sometimes also the adult cardiac conduction tissue may be affected by such antibodies. The exact arrhythmogenic mechanisms involved in foetus/newborns and adults, respectively, have not been completely clarified as yet. However, increasing evidence suggests that anti‐Ro/SSA antibodies may trigger rhythm disturbances through an inhibiting cross‐reaction with several cardiac ionic channels, particularly the calcium channels (L‐type and T‐type), but also the potassium channel hERG, whose different expression and involvement in the cardiac electrophysiology during lifespan might account for the occurrence of age‐related differences.

Evaluation of Transplacental Treatment for Fetal Congenital Bradyarrhythmia

“…The second theory involves electrophysiologic interference of antiRo/SSA antibodies with heart conduction (electrophysiological theory). 20 Consistent with these respective theories, steroids and i.v. immunoglobulins are used for anti-inflammatory treatment, while β-sympathomimetics are given for fetal pacing.…”

“…immunoglobulins are given as anti-inflammatory treatment, while β-sympathomimetics are used for fetal pacing. 20 A recent…”

Pathogenesis of the Novel Autoimmune-Associated Long-QT Syndrome

“…11,12 Interestingly, in the adult patients, anti-Ro Ab positivity is associated with repolarization abnormalities (QTc prolongation) [7][8][9][10] but not with conduction abnormalities (complete atrioventricular block), which is well described in children born to mothers with anti-Ro Abs. 13,14 Accordingly, it is assumed that the adult heart does not represent an immunological target for anti-Ro Abs.…”

Late Ventricular Potentials in Cardiac and Extracardiac Diseases

“…LVPs were recorded in patients with systemic lupus (Paradiso et al, 2001;Wranicz et al, 2001), and the depolarization abnormalities revealed by SAECG reflect a longer extent of myocardial fibrosis and echocardiography and SAECG alterations are markers of subclinical myocardial involvement. Increasing evidence suggest that anti-Ro/SSA antibodies may trigger rhythm disturbances due to an inhibiting cross-reaction with several cardiac calcium and potassium ionic channels (Lazzerini et al, 2010). So far, the evidence related to electrocardiographic disturbances in this setting is restricted to studies with small number of patients (Teixeira, et al, 2010).…”

“…So far, the evidence related to electrocardiographic disturbances in this setting is restricted to studies with small number of patients (Teixeira, et al, 2010). The mechanisms of arrhythmias are related to the inflammatory process of pericarditis and myocarditis, atherosclerotic myocardial ischemia, increased sympathetic activity, vasculitis of small vessels with collagen deposits and anti-Ro/SSA antibodies (Lazzerini et al, 2010;Teixeira, et al, 2010). Cardiac sarcoidosis affects the myocardium, pericardium and endocardium, and the disease may present with: atrioventricular and intraventricular conduction disturbances, ventricular arrhythmias and HF.…”