Ventricular Tachycardia and Sudden Cardiac Death in Connective Tissue Diseases: Can Cardiovascular Magnetic Resonance Play a Role?

Abstract

Ventricular tachycardia (VT) and sudden cardiac death (SCD) are deleterious manifestations of cardiac involvement in connective tissue diseases (CTD). In rheumatoid arthritis (RA), the commonest cause of SCD is coronary artery disease that may lead to acute coronary syndrome and VT. In systemic lupus erythematosus (SLE), VT is due either to coronary artery disease or to acute myocarditis. VT/SCD can be also assessed in polymyostis (PM) and dermatomyositis (DM). Finally, VT was described in 7-13%, while SCD in 5-21% of unselected SSc patients. Cardiovascular magnetic resonance (CMR) has been already used as screening tool in CTDs, because of its capability to evaluate noninvasively and without radiation, function, inflammation, perfusion defects and fibrosis. Apart of the impaired ventricular function, which can be by itself a predisposing factor for VT/SCD, the commonest causes that can potentially lead to VT/SCD in CTDs are myocarditis, coronary artery disease with ischemic type fibrosis, microvascular disease, nonischemic type fibrosis and heart failure. The detection of perfusion defects by CMR can be served as a tool to select those patients, who should undergo x ray coronary angiography and/or angioplasty. The location and extent of myocardial scar can guide further electrophysiologic study and/or intervention. On the other hand, in those with myocarditis, microvascular disease and/or heart failure, a modification in both cardiac and rheumatic medication may be recommended after evaluation of CMR findings. CMR in CTDs with VT/SCD may guide risk stratification, rheumatic and cardiac therapeutic decision making and therefore it should be included as a reliable adjunct in the evaluation of these patients.