RT Journal Article
SR Electronic
T1 Arrhythmic Risk During Acute Infusion of Infliximab: A Prospective, Single-blind, Placebo-controlled, Crossover Study in Patients with Chronic Arthritis
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 1958
OP 1965
VO 35
IS 10
A1 PIETRO ENEA LAZZERINI
A1 MAURIZIO ACAMPA
A1 MOHAMED HAMMOUD
A1 SILVIA MAFFEI
A1 PIER LEOPOLDO CAPECCHI
A1 ENRICO SELVI
A1 STEFANIA BISOGNO
A1 FRANCESCA GUIDERI
A1 MAURO GALEAZZI
A1 FRANCO LAGHI PASINI
YR 2008
UL http://www.jrheum.org/content/35/10/1958.abstract
AB Objective Reports suggest that infliximab (IFX) may be associated with life-threatening tachyarrhythmias and bradyarrhythmias. We evaluated the prevalence of cardiac rhythm disorders during acute infusion of IFX in a prospective, single-blind, placebo-controlled crossover study of patients with chronic arthritis. Effects of the drug on measures of arrhythmia risk such as QT interval and heart rate variability (HRV) were evaluated. Methods Seventy-five patients with spondyloarthritis (SpA; n = 55) or rheumatoid arthritis (RA) underwent an ambulatory 12-channel electrocardiogram (ECG) recording to monitor cardiac arrhythmias, QT interval, and HRV during the infusion of IFX and saline (placebo). Results The occurrence of both tachyarrhythmias and bradyarrhythmias was not statistically different during IFX or placebo infusion. During IFX infusion, new-onset ventricular tachyarrhythmias had an 8% incidence (2.7% with placebo; OR 3.17, 95% CI 0.61–16.26) and were more severe. In these patients, mainly with RA, baseline-corrected QT interval and HRV values were significantly prolonged and depressed, respectively, in comparison with subjects without such arrhythmias. IFX acutely produced a significant shift toward a relative vagal prevalence without affecting QT interval measurements. Conclusion New-onset cardiac arrhythmias, particularly ventricular tachyarrhythmias, developed during IFX infusion, but their incidence did not achieve statistical significance. We identified some specific risk factors possibly characteristic of the small subset of patients with a higher risk for ventricular arrhythmias. The acute effects of IFX on autonomic balance may substantiate the role of the complex interaction between autonomic nervous system and inflammation during chronic arthritis.