Incidence and Prevalence of Cardiac Arrhythmias in Pericardial Syndromes

Abstract

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.

Keywords: anticoagulation; arrhythmias; atrial fibrillation; myopericarditis; pericardial syndromes.

Fig. 1.

Arrhythmias in patients with pericardial inflammation. New-onset atrial fibrillation with rapid ventricular response (A), in a patient with acute pericarditis and large circumferential pericardial effusion (B), without signs of hemodynamic compromise. Arrhythmia converted spontaneously after 12 hours to sinus rhythm (C). Pericardial effusion regressed almost completely after 14 days of anti-inflammatory treatment (D). PEF, pericardial effusion; LV, left ventricle; RV, right ventricle; LA, left atrium; RA, right atrium; *Depicts residual pericardial effusion after anti-inflammatory treatment.