During Review Preparation, a Very Profitable Correspondence Among the Authors Evidenced

We selected one of the most frequent manifestations in systemic sclerosis (SSc) patients associated with a poor outcome and which, at the same time, lack of recent studies. Then, we decided to prepare a review in order to clarify prevalence, specifities, risk factors and management of arrhythmias and conduction abnormalities. The review “Cardiac arrhythmias and conduction defects in systemic sclerosis.Alessandra Vacca, Christophe Meune, Jessica Gordon, Lorinda Chung, Susanna Proudman, ShervinAssassi, Mandana Nikpour, Tatiana S. Rodriguez-Reyna, Dinesh Khanna, Robert Lafyatis, Marco Matucci-Cerinic, Oliver Distler, YannickAllanore, on behalf of SCTC (Scleroderma Clinical Trial Consortium) cardiac sub-committee.” has now been accepted for publication in Rheumatology (Oxford).

During review preparation, a very profitable correspondence among the authors evidenced some important points which need to be clarified, especially as regards diagnostic workup and therapy. Everybody agrees that standard ECG should be routinely performed in all SSc patients, while less consent has been reached with regards to 24h-Holter ECG monitoring. We assumed that it might be considered a part of routine evaluation in SSc patients, even if being asymptomatic, at 1-2 years time interval. But a validation study to determine the possible impact of such an attitude and the ideal time interval is warranted. Some authors suggested to assess in a survey how many centers do regular evaluation of arrhythmias and conduction defects (real life), and this could be the first step to perform a case-control study.

Another important issue regards the best treatment, should it be specific for SSc patients? Obviously it should be. Since different classes of anti-arrhythmic drugs are available, and considered that SSc patients may have multiple organs involved and take concomitant drugs, the choice of treatment must be personalized to the individual patient (see review for major details).

In conclusion, this review does not provide any guidelines but evidenced some unresolved issues. An ad hoc committee to share opinions and data, eventually providing evidence based recommendations also in different stages of the disease, as well as to enable to differentiate between mild abnormalities and those which can lead to a fatal outcome and decide whether or not an appropriate treatment might affect the disease process and improve the overall prognosis of SSc patients,is warranted.

For any information and/or to join SCTC cardiac sub-committee please refer to: Alessandra Vacca,