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Arrhythmic Risk During Acute Infusion of Infliximab: A Prospective, Single-blind, Placebo-controlled, Crossover Study in Patients with Chronic Arthritis PIETRO ENEA LAZZERINI, MAURIZIO ACAMPA, MOHAMED HAMMOUD, SILVIA MAFFEI, PIER LEOPOLDO CAPECCHI, ENRICO SELVI, STEFANIA BISOGNO, FRANCESCA GUIDERI, MAURO GALEAZZI, and FRANCO LAGHI PASINI
ABSTRACT. 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. (First Release Aug 15 2008; J Rheumatol 2008;35:1958-65) Key Indexing Terms:
INFLIXIMAB
From the Department of Clinical Medicine and Immunological Sciences, Divisions of Clinical Immunology, Internal Medicine, Rheumatology and Cardiology, University of Siena, Siena, Italy. P.E. Lazzerini, MD, Division of Clinical Immunology; M. Acampa, MD, PhD, Division of Internal Medicine; M. Hammoud, MD, Division of Rheumatology; S. Maffei, MD, Division of Cardiology; P.L. Capecchi, MD, Associate Professor, Division of Clinical Immunology; E. Selvi, MD, PhD; S. Bisogno, MD, PhD; F. Guideri, MD, Research Fellow; M. Galeazzi, MD, Professor, Division of Rheumatology; F. Laghi Pasini, MD, Professor, Division of Clinical Immunology. Address reprint requests to Dr. P.E. Lazzerini, Department of Clinical Medicine and Immunological Sciences, Division of Clinical Immunology, University of Siena, Siena, Italy. E-mail: pietroenea@yahoo.it Accepted for publication May 2, 2008. |
