Michela Casella1, Marco Bergonti2, Maria Lucia Narducci3, Simone Persampieri4, Alessio Gasperetti5, Edoardo Conte4, Valentina Catto4, Corrado Carbucicchio4, Federico Guerra6, Gianluca Pontone4, Daniele Andreini7, Cristina Basso8, Luigi Di Biase9, Pasquale Santangeli10, Andrea Natale11, Gemma Pelargonio3, Antonio Dello Russo6, Claudio Tondo7. 1. Centro Cardiologico Monzino, IRCCS, Milano, Italy; Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti Umberto I-Lancisi-Salesi", Ancona, Italy; Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy. 2. Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milano, Italy. Electronic address: bergman21@gmail.com. 3. Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy. 4. Centro Cardiologico Monzino, IRCCS, Milano, Italy. 5. Centro Cardiologico Monzino, IRCCS, Milano, Italy; University Heart Center, University Hospital Zurich, Zürich, Switzerland. 6. Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti Umberto I-Lancisi-Salesi", Ancona, Italy; Department of Biomedical Science and Public Health, Marche Polytechnic University, Ancona, Italy. 7. Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milano, Italy. 8. Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Azienda Ospedaliera-University of Padua, Padova, Italy. 9. Albert Einstein College of Medicine, Montefiore Hospital, Bronx, New York. 10. Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. 11. Texas Cardiac Arrhythmia Institute, St. David's Hospital, Austin, Texas.
Abstract
BACKGROUND: Multiple studies have addressed the importance of anteroseptal scar in patients with nonischemic cardiomyopathy. However, this pattern has never been fully evaluated in patients with prior myocarditis. OBJECTIVE: The purpose of this study was to evaluate whether anteroseptal scar is associated with worse outcome in patients with prior myocarditis and how it affects the efficacy of catheter ablation (CA). METHODS: This was a retrospective study of consecutive patients with prior myocarditis and arrhythmic presentation. Cardiac magnetic resonance and electroanatomic voltage mapping were used to identify the scar pattern. Patients were referred for either CA or escalated antiarrhythmic drug (AAD) therapy. The main outcome was ventricular arrhythmia (VA)-free survival according to the presence of anteroseptal scar. RESULTS: A total of 144 consecutive patients with prior myocarditis were included. Mean age was 42.1 ± 14.9 years, and 58% were men. Ejection fraction was normal in 73% of patients. Anteroseptal scar was present in 44% of cases. Sixty-one patients (42%) underwent CA. Overall, at 2-year follow-up, VA-free survival was 77% in the CA group. After CA, the mean number of AADs taken by each patient decreased from 1.8 to 0.9 per day (p<0.001). The presence of anteroseptal scar was found to be an independent predictor of VA relapse both in patients treated with CA (hazard ratio [HR] 3.6; 95% confidence interval [CI] 1.1-11.4; P = .03) and in the overall population (HR 2.0; 95% CI 1.2-3.5; P = .02) . CONCLUSION: In patients with prior myocarditis and VA, the presence of anteroseptal scar negatively predicts outcomes irrespective of treatment strategy.
BACKGROUND: Multiple studies have addressed the importance of anteroseptal scar in patients with nonischemic cardiomyopathy. However, this pattern has never been fully evaluated in patients with prior myocarditis. OBJECTIVE: The purpose of this study was to evaluate whether anteroseptal scar is associated with worse outcome in patients with prior myocarditis and how it affects the efficacy of catheter ablation (CA). METHODS: This was a retrospective study of consecutive patients with prior myocarditis and arrhythmic presentation. Cardiac magnetic resonance and electroanatomic voltage mapping were used to identify the scar pattern. Patients were referred for either CA or escalated antiarrhythmic drug (AAD) therapy. The main outcome was ventricular arrhythmia (VA)-free survival according to the presence of anteroseptal scar. RESULTS: A total of 144 consecutive patients with prior myocarditis were included. Mean age was 42.1 ± 14.9 years, and 58% were men. Ejection fraction was normal in 73% of patients. Anteroseptal scar was present in 44% of cases. Sixty-one patients (42%) underwent CA. Overall, at 2-year follow-up, VA-free survival was 77% in the CA group. After CA, the mean number of AADs taken by each patient decreased from 1.8 to 0.9 per day (p<0.001). The presence of anteroseptal scar was found to be an independent predictor of VA relapse both in patients treated with CA (hazard ratio [HR] 3.6; 95% confidence interval [CI] 1.1-11.4; P = .03) and in the overall population (HR 2.0; 95% CI 1.2-3.5; P = .02) . CONCLUSION: In patients with prior myocarditis and VA, the presence of anteroseptal scar negatively predicts outcomes irrespective of treatment strategy.
Authors: Giovanni Volpato; Paolo Compagnucci; Laura Cipolletta; Quintino Parisi; Yari Valeri; Laura Carboni; Andrea Giovagnoni; Antonio Dello Russo; Michela Casella Journal: Front Cardiovasc Med Date: 2022-08-22
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