Arrhythmias and Conduction Disturbances in Patients with Systemic Sclerosis—A Systematic Literature Review

Abstract

Systemic sclerosis (SSc) is an autoimmune disease characterized by skin and internal organ fibrosis and microvascular impairment, which can affect major organs, including the heart. Arrhythmias are responsible for approximately 6% of deaths in patients with SSc, and mainly occur due to myocardial fibrosis, which causes electrical inhomogeneity. The aim of this study was to determine the frequency of arrhythmias and conduction disturbances in SSc cohorts, and to identify the characteristics and risk factors associated with the occurrence of dysrhythmias in patients with SSc. A systematic literature review using PubMed, Embase, Web of Science and Scopus databases was performed. Full-text articles in English with arrhythmias as the main topic published until 21 April 2022 were included. Most prevalent arrhythmias were premature supraventricular and ventricular contractions, while the most frequent conduction disturbance was represented by right bundle branch block (RBBB). Elevated concentrations of N-terminal prohormones of brain natriuretic peptides (NT-pro BNP) were associated with numerous types of atrial and ventricular arrhythmias, and with the occurrence of RBBB. A lower value of the turbulence slope (TS) emerged as an independent predictor for ventricular arrhythmias. In conclusion, dysrhythmias are frequent in SSc cohorts. Paraclinical and laboratory parameters are useful instruments that could lead to early diagnosis in the course of the disease.

Diagnosis and management of primary heart involvement in systemic sclerosis

“…RBBB, in particular, can be detected in up to 27% of patients with SSc and carries important prognostic implications, as it has been associated with increased cardiac enzymes [17], higher frequency of life-threatening arrhythmias [11] and overall morality [54]. Other frequent conduction disorders detected by standard ECG or Holter include left bundle branch block (LBBB), left anterior fascicular block (LAFB) and atrio-ventricular block (AVB) [56], mainly first-degree AVB (1.3-55%), while thirddegree AVB was rarely detected (2.7%) [56,57]. Prolonged QTc interval and ST segment and T wave changes are also more prevalent in SSc than healthy controls [12,58].…”

The diagnostic efficiency of artificial intelligence based 2 hours Holter monitoring in premature ventricular and supraventricular contractions detection

“…18 In this study, we focused on the diagnostic efficiency of 2 hours short-term AI/CNN-based Holter monitoring (2 h-Holter) for premature ventricular and supraventricular contractions (PVC and PSVC), which are among the most common arrhythmias. 19,20 2 h-Holter analysis was used to predict PSVC and PVC in patients with unknown arrhythmia and was subsequently compared with 24 h-Holter results to assess the sensitivity, specificity, positivepredictive value (PPV), and negative predictive-value (NPV) in detecting PSVC/PVC. Therefore, the present study was performed to address the aforementioned issues and assess a possible association between the diagnostic accuracy of 2 h-Holter monitoring and 24 h-Holter monitoring.…”

From Pathogenesis to Treatment—New Perspectives in Rheumatology

“…Routine screening is needed in order to more readily diagnose and treat patients. This matter was elaborately reviewed by Vrancianu et al [4], with the aim of exploring the risk factors and characteristics of patients that present these manifestations, in order to lower mortality by implementing treatment in the subclinical stage. Supraventricular premature beats (SPB), premature ventricular contractions (PVC), and right bundle branch block (RBBB) were the most prevalent supraventricular and ventricular arrythmias and conduction defects, respectively.…”