Lazaros George, Lazarou Emilia, Tsioufis Panagiotis, Soulaidopoulos Stergios, Valatsou Aggeliki, Karmpalioti Maria, Sakalidis Athanasios, Vlachakis Panayotis K, Vlachopoulos Charalambos, Tsioufis Costas
First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece.
Rev Cardiovasc Med. 2022 Oct 17;23(10):347. doi: 10.31083/j.rcm2310347. eCollection 2022 Oct.
Arrhythmias in pericardial syndromes have been poorly investigated and available data are mainly obtained from relevant studies however having different endpoints from arrhythmias. Thus, the incidence and prevalence of any type of arrhythmias may be actually higher than generally considered. Atrial arrhythmias, mainly atrial fibrillation and flutter have been reported as the most common rhythm disturbances in the setting of acute pericarditis. Concerning pathophysiology of atrial arrhythmias, in contrast to earlier hypothesis that they occur exclusively in the presence of an underlying structural heart disease, recent data support an arrhythmogenic potential of acute pericardial inflammation regardless of the presence of heart disease. In cases of myopericarditis, namely primarily pericarditis with evidence of myocardial involvement (i.e., troponin elevation without however overt left ventricular dysfunction and/or segmental wall motion abnormalities), ventricular arrhythmias appear to prevail. With reference to the rest of pericardial syndromes data on arrhythmias development are even more sparce. In particular, in constrictive pericarditis atrial tachyarrhythmias are the most commonly detected and seem to be related to disease severity and possibly to the underlying etiology. In this review we have summarized the available information on the incidence and prevalence of arrhythmias in pericardial syndromes. We wish to emphasize that the clinical significance of arrhythmias in this setting in terms of prognosis and optimal medical treatment (including need and safety of anticoagulation in atrial fibrillation/flutter complicating acute pericarditis), should be further investigated.
心包综合征中的心律失常研究较少，现有数据主要来自相关研究，但这些研究的终点与心律失常不同。因此，任何类型心律失常的发病率和患病率可能实际上高于普遍认为的水平。房性心律失常，主要是心房颤动和心房扑动，被报道为急性心包炎时最常见的节律紊乱。关于房性心律失常的病理生理学，与早期认为它们仅在存在潜在结构性心脏病时发生的假设相反，最近的数据支持急性心包炎症具有致心律失常的潜力，无论是否存在心脏病。在心肌心包炎的情况下，即主要是心包炎并有心肌受累的证据（即肌钙蛋白升高，但无明显左心室功能障碍和/或节段性室壁运动异常），室性心律失常似乎更为常见。关于其他心包综合征，心律失常发生的数据甚至更为稀少。特别是，在缩窄性心包炎中，房性快速心律失常是最常检测到的，似乎与疾病严重程度以及可能与潜在病因有关。在本综述中，我们总结了心包综合征中心律失常发病率和患病率的现有信息。我们希望强调，在这种情况下，心律失常在预后和最佳药物治疗方面的临床意义（包括房颤/房扑合并急性心包炎时抗凝的必要性和安全性），应进一步研究。
