Gemma Pelargonio1, Gaetano Pinnacchio2, Maria Lucia Narducci3, Maurizio Pieroni4, Francesco Perna2, Gianluigi Bencardino2, Gianluca Comerci2, Antonio Dello Russo5, Michela Casella6, Stefano Bartoletti2, Eleonora Russo7, Filippo Crea1. 1. Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy. 2. Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. 3. Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. Electronic address: marialucia.narducci@policlinicogemelli.it. 4. Cardiovascular Department, San Donato Hospital, Arezzo, Italy. 5. Clinica di Cardiologia e Aritmologia Universitá Politecnica delle Marche, Ancona, Italy. 6. Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy. 7. Department of Cardiovascular Disease, Division of Cardiology, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy.
Abstract
OBJECTIVES: This study sought to assess long-term arrhythmic risk in patients with myocarditis who received an implantable cardioverter-defibrillator (ICD). BACKGROUND: The arrhythmic risk of patients with myocarditis overtime remains poorly known. METHODS: The study enrolled 56 patients with biopsy-proven myocarditis who received an ICD for either primary (57%) or secondary prevention (43%) according to current guidelines. Clinical characteristics, biopsy findings, electrophysiological data from endocardial 3-dimensional electroanatomic voltage mapping, and device interrogation data were analyzed to detect arrhythmic events overtime. Coronary angiography excluded significant coronary artery disease in all patients. RESULTS: At a mean follow-up of 74 ± 60 months (median 65 months), 25 (45%) patients had major ventricular arrhythmias treated by ICD intervention (76% being terminated by ICD shock and 24% by antitachyarrhythmia burst pacing). At multivariable analysis, the presence of sustained ventricular tachycardia on admission (hazard ratio: 13.0; 95% confidence interval: 2.0 to 35.0; p = 0.032) and the extension of the areas of low potentials at the bipolar endocardial mapping (hazard ratio: 1.19; 95% confidence interval: 1.04 to 1.37; p = 0.013) were the only independent predictors of appropriate ICD interventions. A cutoff value of 10% of abnormal bipolar area at electroanatomical ventricular mapping discriminated patients with appropriate ICD interventions with a sensitivity of 89% and a specificity of 85%. CONCLUSIONS: The study demonstrates that the prevalence of life-threatening ventricular arrhythmias in patients with myocarditis receiving an ICD according to current guidelines is high and the arrhythmic risk persists late overtime. Electroanatomical ventricular mapping may be a useful tool to identify patients at greater arrhythmic risk.
OBJECTIVES: This study sought to assess long-term arrhythmic risk in patients with myocarditis who received an implantable cardioverter-defibrillator (ICD). BACKGROUND: The arrhythmic risk of patients with myocarditis overtime remains poorly known. METHODS: The study enrolled 56 patients with biopsy-proven myocarditis who received an ICD for either primary (57%) or secondary prevention (43%) according to current guidelines. Clinical characteristics, biopsy findings, electrophysiological data from endocardial 3-dimensional electroanatomic voltage mapping, and device interrogation data were analyzed to detect arrhythmic events overtime. Coronary angiography excluded significant coronary artery disease in all patients. RESULTS: At a mean follow-up of 74 ± 60 months (median 65 months), 25 (45%) patients had major ventricular arrhythmias treated by ICD intervention (76% being terminated by ICD shock and 24% by antitachyarrhythmia burst pacing). At multivariable analysis, the presence of sustained ventricular tachycardia on admission (hazard ratio: 13.0; 95% confidence interval: 2.0 to 35.0; p = 0.032) and the extension of the areas of low potentials at the bipolar endocardial mapping (hazard ratio: 1.19; 95% confidence interval: 1.04 to 1.37; p = 0.013) were the only independent predictors of appropriate ICD interventions. A cutoff value of 10% of abnormal bipolar area at electroanatomical ventricular mapping discriminated patients with appropriate ICD interventions with a sensitivity of 89% and a specificity of 85%. CONCLUSIONS: The study demonstrates that the prevalence of life-threatening ventricular arrhythmias in patients with myocarditis receiving an ICD according to current guidelines is high and the arrhythmic risk persists late overtime. Electroanatomical ventricular mapping may be a useful tool to identify patients at greater arrhythmic risk.
Authors: Fabiola B Sozzi; Elisa Gherbesi; Andrea Faggiano; Eleonora Gnan; Alessio Maruccio; Marco Schiavone; Laura Iacuzio; Stefano Carugo Journal: Front Cardiovasc Med Date: 2022-06-20
Authors: Bhurint Siripanthong; Babken Asatryan; Thomas C Hanff; Salman R Chatha; Mohammed Y Khanji; Fabrizio Ricci; Daniele Muser; Victor A Ferrari; Saman Nazarian; Pasquale Santangeli; Rajat Deo; Leslie T Cooper; Saidi A Mohiddin; C Anwar A Chahal Journal: JACC Basic Transl Sci Date: 2022-02-09
Authors: Giovanni Volpato; Umberto Falanga; Laura Cipolletta; Manuel Antonio Conti; Gino Grifoni; Giuseppe Ciliberti; Alessia Urbinati; Alessandro Barbarossa; Giulia Stronati; Marco Fogante; Marco Bergonti; Valentina Catto; Federico Guerra; Andrea Giovagnoni; Antonio Dello Russo; Michela Casella; Paolo Compagnucci Journal: Medicina (Kaunas) Date: 2021-03-25 Impact factor: 2.430
Authors: Paolo Compagnucci; Giovanni Volpato; Umberto Falanga; Laura Cipolletta; Manuel Antonio Conti; Gino Grifoni; Giuseppe Ciliberti; Giulia Stronati; Marco Fogante; Marco Bergonti; Elena Sommariva; Federico Guerra; Andrea Giovagnoni; Antonio Dello Russo; Michela Casella Journal: Medicina (Kaunas) Date: 2021-03-17 Impact factor: 2.430