الفهرس 
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Abstract
Systemic lupus erythematosus (SLE), also known simply as lupus, is an autoimmune disease in which the body’s immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary between people and may be mild to severe. Common symptoms include painful and swollen joints, fever, chest pain, hair loss, mouth ulcers, swollen lymph nodes, feeling tired, and a red rash which is most commonly on the face. Often there are periods of illness, called flares, and periods of remission during which there are few symptoms (Hand out of health 2016).
Arrhythmias and conduction system disorders are among the cardiovascular disturbances caused by systemic lupus erythematosus (SLE). Immuno-mediated damage, atherosclerotic complications, or even adverse effect of the treatment (chloroquine-induced cardiotoxicity) seem to be the mechanisms involved more often in the pathophysiology of those disturbances (Teixeira et al. 2002).
Anti-Ro/SSA antibodies (anti-Ro/SSA), almost exclusively belonging to the IgG class, consist of 2 subtypes- (i.e., anti-Ro/SSA-52 kD and anti-Ro/SSA-60 kD) and are frequently detected not only in patients with connective tissue disease (CTD) but also in a significant proportion of apparently healthy subjects (Gupta et al. 2007). The pathogenic role of these antibodies on the conduction system of the immature heart is well recognized. Indeed, considerable evidence links the transplacental passage of anti-Ro/SSA from the mother to the fetus with the risk of developing congenital atrioventricular block (Rautaharju et al. 2009).
The objective of this study is to assess the role of Anti-Ro and Anti-La antibodies as risk factors for arrhythmia in adult patients with systemic lupus erythematosus.
Our study included 70 SLE patients, divided into two groups, first group included 32.9% of cases had abnormal ECG findings, and second group included 67.1% had normal ECG. Regarding ECG findings, we found that 17.1% of our patients had ischemia, 12.9% had sinus tachycardia, and only 1.4% had left bundle branch block, these results was in agreement with Menendez et al. (2013) who reported that common ECG abnormalities were CHB and ischemia.
Regarding relation between ECG abnormality and Anti RO and LA, we found that 41.9% of patients who had positive anti RO and LA had abnormal ECG findings, while 58.1% of them had normal ECG, our results were similar to that by previous studies as Lazzerini et al. (2010), Lazzerini et al. (2004), Lazzerini et al. (2007), Costedoat-Chalumeau et al. (2005), and Pineau et al. (2005) who found that the occurrence of QTc prolongation and other cardiac abnormalities were about more likely in anti-Ro ⁄ SSA-positive than in negative subjects.
Conclusion
Although classically considered invulnerable to the anti-Ro⁄SSA antibodies, recent evidence demonstrated that also the adult heart may represent a target of the arrhythmogenicity of these autoantibodies. However, the specific rhythm disturbances occurring seem to be age related, as demonstrated by the fact that while ventricular repolarization
abnormalities (in particular QTc prolongation) are the predominant finding in the adults, the involvement of conduction system is practically restricted to the foetal heart only.
Moreover, even though the exact arrhythmogenic mechanisms have not been completely clarified as yet, increasing evidence suggests that anti Ro ⁄ SSA antibodies may trigger rhythm disturbances through an inhibiting cross-reaction with several cardiac ionic channels, particularly the calcium channels (L-type and T-type), but also the potassium channel hERG, whose different expression and involvement in the cardiac electrophysiology during lifespan might account for the occurrence of age-related differences.