Eventos arrítmicos no lúpus eritematoso sistêmico

Abstract

Cardiac involvement is present in more than half of the patients with Systemic Lupus Erythematosus (SLE). However, studies on the prevalence of arrhythmias in this disease and laboratorial correlations predictive of their development do not exist. It seems possible that the classic second mortality peak is related to arrhythmias, mainly due to the sudden nature of those deaths. Autoimmune process, atherosclerotic complications, and even adverse effects secondary to the treatment of this disorder (chloroquine cardiotoxicity) seem to be the main pathophysiological mechanisms of those disturbances. The direct participation of autoantibodies, such as anti-Ro/SSA and anti-RNP, is still controversial. All types of AV blocks (AVB), intraventricular conduction disturbances, and sick sinus syndrome have already been described in this disease. Tachycardias identified more often include sinus tachycardia, atrial fibrillation, and atrial ectopies. Long QT syndrome and the presence of late potentials in signal-averaged ECG have also been described in SLE patients and they can be associated with increased mortality rates. Cardiac toxicity secondary to chloroquine could be responsible for several types of arrhythmias. However, few cases of fascicular block evolving to complete AV block have been described. Since these adverse effects are rarely reported, the beneficial anti-inflammatory and immune properties support the use of antimalarials in this disease. A complete cardiologic evaluation should include the conduction system and must be carried out in all SLE patients to identify arrhythmias, therefore preventing symptoms and also sudden cardiac death.

Risk of Arrhythmia Among New Users of Hydroxychloroquine in Rheumatoid Arthritis and Systemic Lupus Erythematosus: A Population‐Based Study

“…However, HCQ has been reported to prolong the QT interval from which life-threatening ventricular arrhythmias could result (13,14). Although a previous study found that HCQ plays a role in increased risk of arrhythmia (8), some recent studies found an association between HCQ and decreased arrhythmic events among SLE patients (6,15,16). Some other studies found no association between HCQ use and the risk of different types of arrhythmic events among RA patients and SLE patients in the literature (17,18).…”

“…Other common cardiovascular disturbances among RA and SLE patients are arrhythmias, including conduction system disorders (4,5). There are a wide range of known causes of arrhythmias, including immune-mediated damage, congenital and acquired heart disease, and the adverse effects of medications (6)(7)(8).…”

An update on cardiovascular disorders in systemic lupus erythematosus

“…68 Patients with SLE develop atrial fibrillation (AF) more frequently than the general population, 32 with the most common arrhythmias being tachyarrhythmias, specifically, sinus tachycardia, AF and atrial ectopies. 69 An association exists between anti-Ro/SSA antibodies and QT prolongation. 70 Myung et al reviewed 12-lead electrocardiogram (ECG) records of 235 SLE patients and assessed 53 patients with abnormalities that included sinus tachycardia (18% of patients), sinus bradycardia (14%), QT prolongation (17%), and tachyarrhythmias (6%) such as AF, atrial flutter, atrial tachycardia, and atrioventricular nodal reentrant tachycardia (AVNRT)/atrioventricular reentry tachycardia (AVRT).…”

Autoantibodies for Cardiac Channels and Sudden Cardiac Death and its Relationship to Autoimmune Disorders

“…Patients with autoimmune conditions that have a high predisposition for cardiac involvement such as SLE, SSc, Rheumatoid arthritis etc. should undergo electrophysiological studies for screening purposes and AICD implantation is recommended in patients with ventricular tachycardia or reduced left ventricular ejection fraction [ 45 , 47 ].…”