The Role of Autoantibodies in Arrhythmogenesis

Abstract

Purpose of review: The role of autoantibodies in arrhythmogenesis has been the subject of research in recent times. This review focuses on the rapidly expanding field of autoantibody-mediated cardiac arrhythmias.

Recent findings: Since the discovery of cardiac autoantibodies more than three decades ago, a great deal of effort has been devoted to understanding their contribution to arrhythmias. Different cardiac receptors and ion channels were identified as targets for autoantibodies, the binding of which either initiates a signaling cascade or serves as a biomarker of underlying remodeling process. Consequently, the wide spectrum of heart rhythm disturbances may emerge, ranging from atrial to ventricular arrhythmias as well as conduction diseases, irrespective of concomitant structural heart disease or manifest autoimmune disorder. The time has come to acknowledge autoimmune cardiac arrhythmias as a distinct disease entity. Establishing the autoantibody profile of patients will help to develop novel treatment approaches for patients.

Keywords: Atrial fibrillation; Autoantibodies; Autoimmunity; Cardiac arrhythmias; Cardiac conduction disease; Ventricular arrhythmia.

Fig. 1

Summary of autoantibodies related to atrial fibrillation, inappropriate sinus tachycardia, conduction diseases and ventricular arrhythmias, identified so far. ß ß-adrenergic receptor, Ca_v1.2 L-type voltage-gated Ca²⁺ channel, Ca_v3.1 T-type voltage-gated Ca²⁺ channel, HSP heat shock protein, K_v7.1 voltage-gated KCNQ1 K⁺ channel, K_v11.1 voltage-gated KCNH2 K⁺ channel, M₂ M₂-muscarinic acetylcholine receptor, Na_v1.5 voltage-gated Na⁺ channel, VT ventricular tachyarrhythmia, ± stimulation/inhibition. This image was produced using images modified from Servier Medical Art