Plastiras Sotiris C, Moutsopoulos Haralampos M
Echocardiography Unit, Bioiatriki SA, Bioiatriki Healthcare Group, Athens, Greece.
Medical Sciences/Immunology, Academy of Athens, Athens, Greece.
Arrhythm Electrophysiol Rev. 2021 Apr;10(1):17-25. doi: 10.15420/aer.2020.43.
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.
节律和传导障碍以及心源性猝死是自身免疫性风湿性疾病（ARD）中心脏受累的重要表现，对发病率和死亡率有严重影响。虽然潜在的致心律失常机制是多因素的，但心肌纤维化起着关键作用。它占心脏死亡率的很大一部分，可能表现为房性和室性心律失常、传导系统异常、双心室心力衰竭或猝死。在ARD患者中，心肌纤维化被认为是炎症过程或冠状动脉闭塞性疾病导致心脏受累的标志。心肌纤维化为折返环路构成病理基础。室上性早搏、快速心律失常、心室活动和传导障碍在ARD患者中并不少见，在系统性红斑狼疮、系统性硬化症、类风湿关节炎、炎性肌病和抗中性粒细胞胞浆抗体相关血管炎患者中更为常见。在本综述中，提供了心脏风湿病这一新兴领域中节律和传导障碍的类型、相对患病率及潜在机制。
