Giovanni Peretto1, Simone Sala2, Stefania Rizzo3, Anna Palmisano4, Antonio Esposito4, Francesco De Cobelli4, Corrado Campochiaro5, Giacomo De Luca5, Luca Foppoli6, Lorenzo Dagna5, Gaetano Thiene3, Cristina Basso3, Paolo Della Bella2. 1. Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital and Vita-Salute University, Milan, Italy. Electronic address: peretto.giovanni@hsr.it. 2. Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital and Vita-Salute University, Milan, Italy. 3. Department of Cardiovascular Pathology, Padua Hospital and University, Padua, Italy. 4. Department of Cardiovascular Radiology and Cardiac Magnetic Resonance Unit, IRCCS San Raffaele Hospital and Vita-Salute University, Milan, Italy. 5. Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital and Vita-Salute University, Milan, Italy. 6. IRCCS San Raffaele Hospital and Vita-Salute University, Milan, Italy.
Abstract
BACKGROUND: Ventricular arrhythmias (VAs) have never been systematically investigated in patients with myocarditis at different stages. OBJECTIVES: The purpose of this study was to compare baseline and follow-up characteristics of VAs in patients with active myocarditis (AM) versus previous myocarditis (PM). METHODS: A total of 185 consecutive patients (69% males, age 44 ± 15 years, left ventricular ejection fraction 49 ± 14%) with myocarditis and VA at index hospitalization, including ventricular fibrillation, ventricular tachycardia (VT), nonsustained ventricular tachycardia (NSVT), and Lown's grade ≥2 premature ventricular complexes, were enrolled. AM and PM groups were defined based on endomyocardial biopsy and cardiac magnetic resonance findings. A subset of patients (n = 46, 25%) also underwent electroanatomic mapping and VA transcatheter ablation. RESULTS: At presentation, AM patients (n = 123, 66%) more commonly had ventricular fibrillation (8 cases vs. 0 cases; p = 0.053), and both irregular (61% vs. 11%; p < 0.001) and polymorphic VA (NSVT and VT: 19% vs. 2%; p = 0.002; premature ventricular complexes: 63% vs. 16%; p < 0.001). Only in PM patients with NSVT or VT, the dominant morphology (right-bundle branch block with superior axis) was 100% predictive of abnormal LV inferoposterior substrate at both cardiac magnetic resonance and electroanatomic mapping. At 27 ± 7 months prospective follow-up, 55 patients (30%) experienced malignant VA (AM vs. PM, p = 0.385). Although a prevalence of polymorphic and irregular VA was confirmed in AM patients with persistent inflammation in follow-up (58%), a predominance of monomorphic and regular VA was found in AM patients after myocarditis healing (42%), as well as in PM patients (all p < 0.001). CONCLUSIONS: In myocarditis patients, polymorphic and irregular VA are more common during the active inflammatory phase, whereas monomorphic and regular VA are associated with healed myocarditis.
BACKGROUND:Ventricular arrhythmias (VAs) have never been systematically investigated in patients with myocarditis at different stages. OBJECTIVES: The purpose of this study was to compare baseline and follow-up characteristics of VAs in patients with active myocarditis (AM) versus previous myocarditis (PM). METHODS: A total of 185 consecutive patients (69% males, age 44 ± 15 years, left ventricular ejection fraction 49 ± 14%) with myocarditis and VA at index hospitalization, including ventricular fibrillation, ventricular tachycardia (VT), nonsustained ventricular tachycardia (NSVT), and Lown's grade ≥2 premature ventricular complexes, were enrolled. AM and PM groups were defined based on endomyocardial biopsy and cardiac magnetic resonance findings. A subset of patients (n = 46, 25%) also underwent electroanatomic mapping and VA transcatheter ablation. RESULTS: At presentation, AMpatients (n = 123, 66%) more commonly had ventricular fibrillation (8 cases vs. 0 cases; p = 0.053), and both irregular (61% vs. 11%; p < 0.001) and polymorphic VA (NSVT and VT: 19% vs. 2%; p = 0.002; premature ventricular complexes: 63% vs. 16%; p < 0.001). Only in PM patients with NSVT or VT, the dominant morphology (right-bundle branch block with superior axis) was 100% predictive of abnormal LV inferoposterior substrate at both cardiac magnetic resonance and electroanatomic mapping. At 27 ± 7 months prospective follow-up, 55 patients (30%) experienced malignant VA (AM vs. PM, p = 0.385). Although a prevalence of polymorphic and irregular VA was confirmed in AMpatients with persistent inflammation in follow-up (58%), a predominance of monomorphic and regular VA was found in AMpatients after myocarditis healing (42%), as well as in PM patients (all p < 0.001). CONCLUSIONS: In myocarditispatients, polymorphic and irregular VA are more common during the active inflammatory phase, whereas monomorphic and regular VA are associated with healed myocarditis.
Authors: Bhurint Siripanthong; Saman Nazarian; Daniele Muser; Rajat Deo; Pasquale Santangeli; Mohammed Y Khanji; Leslie T Cooper; C Anwar A Chahal Journal: Heart Rhythm Date: 2020-05-05 Impact factor: 6.343