Ventricular Arrhythmias in Myocarditis: Characterization and Relationships With Myocardial Inflammation
Giovanni Peretto, Simone Sala, Stefania Rizzo, Anna Palmisano, Antonio Esposito, Francesco De Cobelli, Corrado Campochiaro, Giacomo De Luca, Luca Foppoli, Lorenzo Dagna, Gaetano Thiene, Cristina Basso, Paolo Della Bella, Giovanni Peretto, Simone Sala, Stefania Rizzo, Anna Palmisano, Antonio Esposito, Francesco De Cobelli, Corrado Campochiaro, Giacomo De Luca, Luca Foppoli, Lorenzo Dagna, Gaetano Thiene, Cristina Basso, Paolo Della Bella
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.
Keywords: cardiac magnetic resonance; electroanatomic mapping; endomyocardial biopsy; myocarditis; ventricular arrhythmias.
Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed