Arrhythmias and Conduction Disturbances in Autoimmune Rheumatic Disorders

Abstract

Rhythm and conduction disturbances and sudden cardiac death are important manifestations of cardiac involvement in autoimmune rheumatic diseases (ARD), which have a serious impact on morbidity and mortality. While the underlying arrhythmogenic mechanisms are multifactorial, myocardial fibrosis plays a pivotal role. It accounts for a substantial portion of cardiac mortality and may manifest as atrial and ventricular arrhythmias, conduction system abnormalities, biventricular cardiac failure or sudden death. In patients with ARD, myocardial fibrosis is considered to be the hallmark of cardiac involvement as a result of inflammatory process or to coronary artery occlusive disease. Myocardial fibrosis constitutes the pathological substrates for reentrant circuits. The presence of supraventricular extra systoles, tachyarrhythmias, ventricular activity and conduction disturbances are not uncommon in patients with ARDs, more often in systemic lupus erythematosus, systemic sclerosis, rheumatoid arthritis, inflammatory muscle disorders and anti-neutrophil cytoplasm antibody-associated vasculitis. In this review, the type, the relative prevalence and the underlying mechanisms of rhythm and conduction disturbances in the emerging field of cardiorheumatology are provided.

Bradycardia associated with Multisystem Inflammatory Syndrome in Children with COVID-19: a case series

“…In patients with systemic lupus erythematosus (SLE), sinus node dysfunction is related to a small vessel vasculitis and infiltration by granulation tissue, and newborns to SLE mothers may develop rhythm and conduction disorders, up to complete heart block, due to the transplacental passage of anti-Ro/SSA and anti-La/SSB. 21 …”

Endomyocardial substrate of ventricular arrhythmias in patients with autoimmune rheumatic diseases

“…5 Unrelated to coronary artery disease, endomyocardial fibrosis as a result of systemic inflammatory processes and small vessel vasculitis may also constitute a pathological substrate for atrial and ventricular arrhythmias. 4 The main finding…”

“…[1][2][3] Conduction disorders, QT prolongation, and sudden cardiac death are important manifestations of cardiac involvement in autoimmune rheumatic diseases but the substrates of ventricular arrhythmias in patients with autoimmune rheumatic diseases have not been fully elucidated. 4,5 Cardiac MRI is established as a method to characterize the substrate of monomorphic ventricular tachycardia (VT) in nonischemic cardiomyopathy, but it cannot be performed in all patients equipped with defibrillators and pacemakers and may be limited by artifacts even in patients with MRI-compatible devices. Numerous studies have correlated scar regions on DE-MRI to areas of low voltage on electroanatomical mapping, and it is well-accepted that electroanatomical voltage mapping can detect endomyocardial fibrosis and scarring observed on DE-MRI.…”

COVID-19 and the cardiovascular system-current knowledge and future perspectives

“…AF was more prevalent in older patients (13% in ≥ 60 years of age vs 5% in younger patients < 60 years of age) and those with severe COVID-19 (19% in severe vs 3% in mild COVID-19)[ 19 ]. Moreover, in a world-wide survey of 4526 hospitalized COVID-19 patients, 827 were identified having a new cardiac arrhythmia and cardiovascular comorbidities such as hypertension, diabetes mellitus, coronary artery disease, congestive HF were more common in the patients who developed cardiac arrhythmias[ 20 ]. Concerning the life-threatening arrhythmias (ventricular tachycardia and ventricular fibrillation), these were presented in 4%-6% of COVID-19 hospitalized patients and particularly in those with increased troponin levels[ 2 ].…”