The Role of Autoantibodies in Arrhythmogenesis
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INVASIVE ELECTROPHYSIOLOGY AND PACING (E KEVIN HEIST, SECTION EDITOR)
The Role of Autoantibodies in Arrhythmogenesis Jin Li 1,2 Accepted: 11 November 2020 # The Author(s) 2020
Abstract Purpose of Review The role of autoantibodies in arrhythmogenesis has been the subject of research in recent times. This review focuses on the rapidly expanding field of autoantibody-mediated cardiac arrhythmias. Recent Findings Since the discovery of cardiac autoantibodies more than three decades ago, a great deal of effort has been devoted to understanding their contribution to arrhythmias. Different cardiac receptors and ion channels were identified as targets for autoantibodies, the binding of which either initiates a signaling cascade or serves as a biomarker of underlying remodeling process. Consequently, the wide spectrum of heart rhythm disturbances may emerge, ranging from atrial to ventricular arrhythmias as well as conduction diseases, irrespective of concomitant structural heart disease or manifest autoimmune disorder. Summary The time has come to acknowledge autoimmune cardiac arrhythmias as a distinct disease entity. Establishing the autoantibody profile of patients will help to develop novel treatment approaches for patients. Keywords Atrial fibrillation . Autoantibodies . Autoimmunity . Cardiac arrhythmias . Cardiac conduction disease . Ventricular arrhythmia
Introduction With the conceptualization of the contradictory capacity of the immune system to self-defend and self-destruct at the same time, the term autoimmunity was first coined over a century ago [1•, 2]. Beyond the philosophical implication, this vital paradox shaped our present-day understanding of disease development when self-tolerance is lost and autoantibodies considered a sine qua non of the condition [1•, 3]. The contribution of autoimmunity in cardiovascular diseases in general is largely under-recognized, even more in the context of heart rhythm disturbances. While anatomical features and genetic background were classically seen as the substrates for cardiac arrhythmias, in recent years, it has become increasingly clear that functional autoantibodies can induce arrhythmias by
This article is part of the Topical Collection on Invasive Electrophysiology and Pacing * Jin Li [email protected]; [email protected] 1
Institute of Biochemistry and Molecular Medicine, University of Bern, Bühlstrasse 28, 3012 Bern, Switzerland
2
Department of Cardiology, Lausanne University Hospital, rue du Bugnon 46, 1011 Lausanne, Switzerland
interfering with ion channels and receptors, the key determinants of cardiac electrophysiology. This review focuses on autoantibody-mediated cardiac arrhythmias, classifying them in three sections, according to their origin: atrial, nodal, and ventricular (Fig. 1). Table 1 summarizes the current literature on autoantibody-induced ECG abnormalities, the prevalence, and associated clinical features.
Autoantibodies and Atrial Arrhythmias The first evidence supporting a possible role of autoantibodies in the development of atrial ar
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