Autoantibody-mediated cardiac arrhythmias: mechanisms and clinical implications.
Cardiac arrhythmias, including conduction defects and tach- yarrhythmias, represent an important source of morbidity and mortality in industrialized countries. Among the different pathophysiological mechanisms involved in the arrhythmogenesis, an inappropriate activation of the immune system represents a field of recent increasing interest. In fact, a large amount of studies suggest that specific autoantibody may be significantly involved in the pathogenesis of cardiac arrhythmias not only in the course of systemic autoimmune disease, but also in a number of rhythm disorders currently classified as "idiopathic." Although the strongest evidence concerns the relationship between anti-Ro/SSA antibodies and the development of congenital heart block in foetus and newborn, other specific autoantibodies demonstrated the aptitude to affect directly the myocardial tissue, thus producing interference in its bioelectric activity thereby leading to rhythm disorders, also life-threatening. The identification of an immunological autoantibody-mediated mechanism opens new perspectives in the treatment and prevention of cardiac arrhythmias in such patients, including the use of immunosuppressive agents and/or the removal of autoantibodies by immuno-adsorption technique.
Lazzerini
Pietro Enea
PE
Department of Clinical Medicine and Immunological Sciences, Division of Clinical Immunology, University of Siena, Siena, Italy. pietroenea@yahoo.it
Capecchi
Pier Leopoldo
PL
Guideri
Francesca
F
Acampa
Maurizio
M
Selvi
Enrico
E
Bisogno
Stefania
S
Galeazzi
Mauro
M
Laghi-Pasini
Franco
F
D000328:Adult; D000974:Antibodies, Antinuclear / Q000009:adverse effects; D001145:Arrhythmias, Cardiac / Q000151:congenital / Q000453:epidemiology / Q000276:immunology* / Q000503:physiopathology; D001323:Autoantibodies / Q000009:adverse effects*; D001327:Autoimmune Diseases / Q000151:congenital / Q000453:epidemiology / Q000503:physiopathology; D006329:Heart Conduction System / Q000276:immunology / Q000503:physiopathology; D006801:Humans; D007231:Infant, Newborn; D043585:Receptor, Muscarinic M2 / Q000276:immunology; D011943:Receptors, Adrenergic, beta / Q000276:immunology
D000974:Antibodies, Antinuclear; D001323:Autoantibodies; D043585:Receptor, Muscarinic M2; D011943:Receptors, Adrenergic, beta