title: Electrocardiography in 110 patients with systemic sclerosis: a cross-sectional comparison with population-based controls.
abstract: OBJECTIVE
  Patchy fibrosis of the myocardium is thought to cause conduction abnormalities in patients with systemic sclerosis (SSc). We compared the prevalence and type of rhythm/conduction disturbances in 74% of the SSc patients in Stockholm County and controls.
  
  
  METHODS
  A total of 110 SSc patients (age 62 ± 12 years) fulfilling the American College of Rheumatology (ACR) criteria for SSc and 105 gender- and age-matched controls participated in this study. A 12-lead resting electrocardiogram (ECG) was performed in all participants. The first 49 patients and 42 controls also underwent a 22-24-h Holter ECG recording. Associations with disease subsets, autoantibodies, cardiovascular risk factors, and left ventricular ejection fraction (LVEF), as estimated by echocardiography, were investigated.
  
  
  RESULTS
  Abnormal ECGs were found in 28% of patients and 17% of controls (p = 0.05). Atrioventricular (AV) and/or intraventricular (IV) conduction abnormalities were found in 15% of patients and 5% of controls (p < 0.01). Four patients, but no controls, had low anteroseptal R-wave/septal Q-wave patterns with narrow QRS complexes, simulating a septal wall infarction pattern. Patients had more abnormal Holter ECG recordings than controls (38% vs. 17%, p = 0.05). All participants with a normal resting ECG had an LVEF ≥ 50%.
  
  
  CONCLUSIONS
  Although ECGs are inexpensive, commonly available screening tools, to detect arrhythmias, such as frequent ventricular extrasystoles (VES), Holter tracings should be performed. The frequencies of AV and/or IV conduction abnormalities and septal Q waves/low R waves have not changed since 1985. The unmet need of anti-fibrotic treatment in SSc is underscored by these findings.
authors.affiliation: Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet , Stockholm , Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Nordin
authors.forename: L
authors.initials: L
authors.lastname: Björnådal
authors.forename: A
authors.initials: A
authors.lastname: Larsson
authors.forename: E
authors.initials: E
authors.lastname: Svenungsson
authors.forename: K
authors.initials: K
authors.lastname: Jensen-Urstad
mesh_terms: D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler; D004562:Electrocardiography / Q000379:methods*; D015716:Electrocardiography, Ambulatory / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment; D012595:Scleroderma, Systemic / Q000150:complications / Q000175:diagnosis*; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D013318:Stroke Volume; D013548:Sweden; D014505:Urban Population; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology