Cardiovascular Involvement in Systemic Lupus Erythematosus: Focus on Arrhythmias

Area of Science:

• Cardiology
• Rheumatology
• Immunology

Background:

• Systemic lupus erythematosus (SLE) frequently presents with diverse cardiovascular manifestations.
• These include pericardial, myocardial, valvular, and coronary artery involvement, alongside conduction abnormalities.
• These cardiac issues can act as substrates or triggers for cardiac arrhythmias.

Purpose of the Study:

• To review the cardiac involvement in SLE, focusing on its association with cardiac arrhythmias.
• To explore the epidemiology, mechanisms, diagnostic approaches, and therapeutic impacts on arrhythmias in SLE patients.

Main Methods:

• A narrative review of studies published between 2015 and 2025.
• Searched PubMed for literature on cardiovascular involvement and arrhythmias in SLE.
• Focused on epidemiology, mechanisms, diagnostics, and treatment effects.

Main Results:

• Cardiac manifestations in SLE (e.g., lupus pericarditis, myocarditis, endocarditis, vasculitis, fibrosis) create a substrate for arrhythmia risk.
• Arrhythmias in SLE stem from structural heart disease, inflammation, immune dysregulation, microvascular issues, autonomic imbalance, oxidative stress, and treatment side effects.
• Arrhythmias in SLE are often overlooked, with limited data on disease-modifying drug effects.

Conclusions:

• SLE-associated cardiovascular damage, inflammation, and therapies contribute to arrhythmias through complex mechanisms.
• Limited literature exists on arrhythmias secondary to cardiovascular damage in SLE patients.
• Early electrical issue detection, regular cardiovascular evaluation, and multidisciplinary cardio-rheumatology approaches are vital for improved outcomes.