National Heart and Lung Institute, Imperial College London, United Kingdom.
Department of Surgery and Cancer, Imperial College London, United Kingdom.
Am J Physiol Heart Circ Physiol. 2020 Nov 1;319(5):H1008-H1020. doi: 10.1152/ajpheart.00401.2020. Epub 2020 Sep 18.
Chronic inflammatory disorders, including rheumatoid arthritis (RA), are associated with a twofold increase in the incidence of sudden cardiac death (SCD) compared with the healthy population. Although this is partly explained by an increased prevalence of coronary artery disease, growing evidence suggests that ischemia alone cannot completely account for the increased risk. The present review explores the mechanisms of cardiac electrophysiological remodeling in response to chronic inflammation in RA. In particular, it focuses on the roles of nonischemic structural remodeling, altered cardiac ionic currents, and autonomic nervous system dysfunction in ventricular arrhythmogenesis and SCD. It also explores whether common genetic elements predispose to both RA and SCD. Finally, it evaluates the potential dual effects of disease-modifying therapy in both diminishing and promoting the risk of ventricular arrhythmias and SCD.
慢性炎症性疾病，包括类风湿关节炎（RA），与健康人群相比，其突发性心脏死亡（SCD）的发生率增加了一倍。尽管这在一定程度上可以解释为冠状动脉疾病的患病率增加，但越来越多的证据表明，单纯的缺血并不能完全解释这种风险的增加。本综述探讨了 RA 慢性炎症对心脏电生理重构的机制。特别是，它侧重于非缺血性结构重构、心脏离子电流改变和自主神经系统功能障碍在室性心律失常和 SCD 中的作用。它还探讨了常见的遗传因素是否容易导致 RA 和 SCD。最后，它评估了疾病修饰疗法在减少和增加室性心律失常和 SCD 风险方面的潜在双重作用。
