Atrial Fibrillation Associated With Systemic Lupus Erythematosus and Use of Methylprednisolone

Abstract

Systemic lupus erythematosus is known to have cardiac manifestations consisting of pericarditis, myocarditis, endocarditis, and coronary vasculitis. Pericarditis is the most common cardiac manifestation of systemic lupus erythematosus. Myocarditis may be suspected in patients presenting with unexplained tachycardia, conduction disturbances, unexplained systolic dysfunction with or without heart failure, or arrhythmias. The development of arrhythmias in systemic lupus erythematosus could be secondary to pericarditis, myocarditis, or ischemia caused by coronary vasculitis. The development of atrial fibrillation in systemic lupus erythematosus is not commonly reported. There have been few reports on the patients developing atrial fibrillation after being started on methylprednisolone therapy. Described here is a case of the development of atrial fibrillation in a newly diagnosed 37-year-old patient with systemic lupus erythematosus who was started on intravenous methylprednisolone therapy.

Glucocorticoid Use and Risk of Atrial Fibrillation or Flutter

“…27 Glucocorticoids may also increase plasma volume and induce hypokalemia by mineralocorticoid-like action, 2 and it has been suggested that even a subclinical fluctuation of serum potassium level from a local cellular potassium efflux owing to a direct effect on the cell membrane may induce arrhythmias. 7,8 In conclusion, this large, population-based, case-control study showed that current use of systemic glucocorticoids is associated with increased risk of atrial fibrillation or flutter. …”

Drug-induced atrial fibrillation

“…High doses of corticosteroids are standard treatment for a wide array of medical disorders. There are several case reports of AF after pulse methylprednisolone therapy: in two patients with multiple sclerosis (40,41), two children with nephrotic syndrome (one of them having systemic lupus erythematosus [SLE]) (42), in a man with SLE (43), and in a woman with rheumatoid arthritis (44). Fujimoto et al (45) postulated that methylprednisolone mediates potassium efflux via a direct effect on the cell membrane.…”

Czy stosowanie dużych dawek metyloprednizolonu w dożylnych pulsach u chorych z orbitopatią Gravesa jest bezpieczne?

“…GCS therapy. Among them we can distinguish: atrial fibrillation [23][24][25][26], atrial flutter [27], junctional rhythm [28], ventricular tachycardia [29], supraventricular tachycardia [20], severe bradycardia [30][31][32]), asystole [28], cardiovascular collapse [33,34], and sudden death [20,35,36]. The incidence of significant, life-threatening cardiac arrhythmias after i.v.…”

“…U chorych leczonych i.v. GCS stwierdzano: migotanie przedsionków [23][24][25][26], trzepotanie przedsionków [27] , rytm węzłowy [28], częstoskurcz komorowy [29] i nadkomorowy [20], bradykardię [30][31][32], nagłe zatrzymanie krążenia [28,33,34], nagły zgon sercowy [20,35,36]. Należy zwrócić uwagę, że zagrażające życiu zaburzenia rytmu serca częściej były obserwowane u chorych palących papierosy, otyłych bądź u pacjentów z rozpoznaną wcześniej chorobą serca [18].…”