Sudden cardiac death in patients with rheumatoid arthritis

Abstract

An increased cardiovascular morbidity and mortality, including the risk of sudden cardiac death (SCD), has been shown in patients with rheumatoid arthritis (RA). Abnormalities in autonomic markers such as heart rate variability and ventricular repolarization parameters, such as QTc interval and QT dispersion, have been associated with sudden death in patients with RA. The interplay between these parameters and inflammation that is known to exist with RA is of growing interest. In this article, we review the prevalence and predictors of SCD in patients with RA and describe the potential underlying mechanisms, which may contribute to this. We also review the impact of biologic agents on arrhythmic risk as well as cardiovascular morbidity and mortality.

Keywords: Sudden death; Rheumatoid arthritis; Cardiovascular; QT; Autonomic nervous system; Arrhythmia

Core tip: Patients with rheumatoid arthritis are twice as likely to experience sudden cardiac death (SCD). This excess risk can only partially be explained by the higher rates of heart failure and ischaemic heart disease. Abnormalities of the autonomic nervous system, such as decreased heart rate variability, and abnormalities of ventricular repolarization parameters, such as QTc interval and QT dispersion, have also been implicated. In this article we review the interplay between these parameters and inflammation, exploring whether biologic agents and disease modifying anti-rheumatic drugs may have a role in reducing the burden of SCD.