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Review
. 2019 Dec 10;9(4):217.
doi: 10.3390/diagnostics9040217.

Arrhythmogenic Inflammatory Cardiomyopathy in Autoimmune Rheumatic Diseases: A Challenge for Cardio-Rheumatology

Sophie I Mavrogeni  1 , George Markousis-Mavrogenis  1 , Constantina Aggeli  2 , Dimitris Tousoulis  2 , George D Kitas  3 , Genovefa Kolovou  1 , Efstathios K Iliodromitis  4 , Petros P Sfikakis  5
Affiliations
Review

Arrhythmogenic Inflammatory Cardiomyopathy in Autoimmune Rheumatic Diseases: A Challenge for Cardio-Rheumatology

Sophie I Mavrogeni et al. Diagnostics (Basel). .

Abstract

Ventricular arrhythmia (VA) in autoimmune rheumatic diseases (ARD) is an expression of autoimmune inflammatory cardiomyopathy (AIC), caused by structural, electrical, or inflammatory heart disease, and has a serious impact on a patient's outcome. Myocardial scar of ischemic or nonischemic origin through a re-entry mechanism facilitates the development of VA. Additionally, autoimmune myocardial inflammation, either isolated or as a part of the generalized inflammatory process, also facilitates the development of VA through arrhythmogenic autoantibodies and inflammatory channelopathies. The clinical presentation of AIC varies from oligo-asymptomatic presentation to severe VA and sudden cardiac death (SCD). Both positron emission tomography (PET) and cardiovascular magnetic resonance (CMR) can diagnose AIC early and be useful tools for the assessment of therapies during follow-ups. The AIC treatment should be focused on the following: (1) early initiation of cardiac medication, including ACE-inhibitors, b-blockers, and aldosterone antagonists; (2) early initiation of antirheumatic medication, depending on the underlying disease; and (3) potentially implantable cardioverter-defibrillator (ICD) and/or ablation therapy in patients who are at high risk for SCD.

Keywords: autoimmune inflammatory cardiomyopathy; autoimmune myocarditis; autoimmune rheumatic diseases; cardiovascular magnetic resonance; positron emission tomography.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Short axis T2 image showing edema (bright area) in the lateral wall of LV of a patient with SLE presented with VT.
Figure 2
Figure 2
Short axis LGE image showing subepicardial fibrosis (bright area) in the lateral wall of LV of the same patient.
Figure 3
Figure 3
A schematic presentation of the interaction between cardiology and rheumatology in the development of AIC.
See this image and copyright information in PMC

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