RESEARCH - Comparison of frequency of complex ventricular arrhythmias in patients with postive versus negative anti-Ro/SSA and CTD

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Am J Cardiol. 2007 Sep 15;100(6):1029-34. Epub 2007 Jul 6.

Comparison of frequency of complex ventricular arrhythmias in patients

with positive versus negative anti-Ro/SSA and connective tissue

disease.

Lazzerini PE, Capecchi PL, Guideri F, Bellisai F, Selvi E, Acampa M,

Costa A, Maggio R, - E, Bisogno S, Morozzi G, Galeazzi

M, Laghi-Pasini F.

Department of Clinical Medicine and Immunological Sciences, Division

of Clinical Immunology, University of Siena, Italy.

A previous study of electrocardiography at rest showed that

anti-Ro/SSA-positive patients with connective tissue disease (CTD)

frequently had corrected QT (QTc) interval prolongation. Because QTc

interval prolongation is a definite risk factor for arrhythmic sudden

death in the general population, a 24-hour electrocardiographic

monitoring study was performed to investigate the possible relation

between QTc interval prolongation and incidence of ventricular

arrhythmias as a possible expression of immunomediated electric

instability of the myocardium in anti-Ro/SSA-positive patients with

CTD.

The study population consisted of 46 patients with CTD; 26

anti-Ro/SSA-positive and 20 anti-Ro/SSA-negative (control group)

patients (Sjögren's syndrome, 9 and 3 patients; systemic lupus

erythematosus, 4 and 9 patients; systemic sclerosis, 2 and 4 patients;

undifferentiated CTD, 8 and 1 patients; mixed CTD, 2 and 2 patients,

and polymyositis/dermatomyositis, 1 and 1 patient, respectively). All

patients underwent ambulatory Holter electrocardiography to obtain

24-hour monitoring of the QTc interval and ventricular arrhythmias.

With respect to the control group, anti-Ro/SSA-positive patients with

CTD (1) commonly showed QTc interval prolongation (46% vs 5%), and

this abnormality, when present, persisted for the 24 hours (global

mean 24-hour QTc interval 440.5+/-23.4 vs 418.2+/-13.2 ms); (2) had a

higher incidence of complex ventricular arrhythmias (i.e., Lown

classes 2 to 5, 50% vs 10%) also in the absence of detectable cardiac

abnormalities; and (3) in patients with CTD, there is a direct

relation between global mean 24-hour QTc interval and ventricular

arrhythmic load independently of age and disease duration.

In conclusion, anti-Ro/SSA-positive patients with CTD seemed to have a

particularly high risk of developing ventricular arrhythmias. The risk

appeared related mainly to abnormalities in ventricular

electrophysiologic characteristics emerging in the clinical setting as

QTc interval prolongation.

PMID: 17826392

http://www.ncbi.nlm.nih.gov/pubmed/17826392

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