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Electrocardiographic disturbances in children with systemic lupus erythematosus
Mohammed AlTwajery1, Waleed AlMane2, Sulaiman M Al-Mayouf1
1Pediatric Rheumatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Insights
Children with systemic lupus erythematosus (SLE) and anti-Ro/SSA antibodies show a higher risk of heart conduction abnormalities. Hydroxychloroquine use may affect heart rate and QT interval in these pediatric patients.
Area of Science:
- Pediatric Cardiology
- Rheumatology
- Systemic Lupus Erythematosus Research
Background:
- Conduction disturbances in pediatric systemic lupus erythematosus (SLE) are under-researched.
- Neonatal lupus-related heart block is a known complication, but other conduction issues are less understood.
Purpose of the Study:
- To document electrocardiographic (ECG) abnormalities in children diagnosed with SLE.
- To investigate the association between anti-Ro/SSA antibodies, hydroxychloroquine use, and cardiac rhythm disturbances in pediatric SLE patients.
Main Methods:
- Retrospective analysis of 41 pediatric SLE patients from a specialized clinic.
- Evaluation of demographics, disease characteristics, autoantibodies, and medication use.
- Independent review of ECG findings by a pediatric cardiologist.
Main Results:
- ECG abnormalities were present in 29.3% of patients, including ST-T changes and bundle branch blocks.
- Abnormalities were significantly associated with the presence of anti-Ro/SSA antibodies (P < .05) and low platelet count.
- Hydroxychloroquine use was linked to effects on heart rate and QT interval, but not overall ECG abnormalities.
Conclusions:
- Pediatric SLE patients with anti-Ro/SSA antibodies may be predisposed to cardiac conduction issues.
- Hydroxychloroquine may influence specific cardiac parameters like heart rate and QT interval.
- Further prospective research is needed to confirm these findings and guide clinical practice.
Background:
Conduction disturbances other than heart block related to neonatal lupus are rarely explored and reported in children with systemic lupus erythematosus (SLE).
Objective:
To report the electrocardiographic (ECG) abnormalities in children with SLE and assess whether anti-Ro/SSA antibodies and hydroxychloroquine are associated with the rhythm disturbances.
Methods:
This cross-sectional retrospective study comprised patients with SLE who had regular follow-up in the Pediatric Lupus Clinic at King Faisal Specialist Hospital and Research Center-Riyadh. All enrolled patients were evaluated with regard to demographics, age at disease onset, disease duration, clinical and laboratory variables including autoantibodies, disease activity using SLEDAI disease activity index, and medications. An expert pediatric cardiologist reviewed the ECG findings of all enrolled patients independently without knowing the clinical status of the patients.
Results:
A total of 41 (35 females, 6 males) unselected patients with SLE with a mean age of 12.8 (2.5) years and mean follow-up duration of 4 (3) years completed the evaluation. The most frequent manifestations were renal disease (65.8%), followed by musculoskeletal (46.3%), hematological (41.5%), and cardiac involvement (19.5%). Thirty-two had active disease (SLEDAI >4), and the mean of SLEDAI was 9.2 (6.2). ECG abnormalities were seen in 12 patients (29.3%); these changes included ST-T changes (9.8%), right bundle branch block (7.3%), 4 prolonged QT interval (9.8%), and low QRS voltage (2.4%). Thirty-seven (90.3%) patients were on hydroxychloroquine, and 9 patients (22%) had positive anti-Ro/SSA antibodies. ECG abnormalities were associated significantly with anti-Ro/SSA antibodies (P < .05) and a low platelet count (P < .5) but had no association with other autoantibodies, hydroxychloroquine, or SLEDAI score.
Conclusion:
Children with SLE with anti-Ro/SSA antibodies are probably prone to heart conduction abnormalities. However, the heart rate and QT interval were affected by hydroxychloroquine. A larger prospective study is required to allow more definitive conclusions.
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