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Ventricular Arrhythmias in Myocarditis: Characterization and Relationships With Myocardial Inflammation

Peretto, Giovanni ; Sala, Simone ; Rizzo, Stefania ; Palmisano, Anna ; Esposito, Antonio ; De Cobelli, Francesco ; Campochiaro, Corrado ; De Luca, Giacomo ; Foppoli, Luca ; Dagna, Lorenzo ; Thiene, Gaetano ; Basso, Cristina ; Della Bella, Paolo

Journal of the American College of Cardiology, 2020-03, Vol.75 (9), p.1046-1057 [Periódico revisado por pares]

United States

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  • Título:
    Ventricular Arrhythmias in Myocarditis: Characterization and Relationships With Myocardial Inflammation
  • Autor: Peretto, Giovanni ; Sala, Simone ; Rizzo, Stefania ; Palmisano, Anna ; Esposito, Antonio ; De Cobelli, Francesco ; Campochiaro, Corrado ; De Luca, Giacomo ; Foppoli, Luca ; Dagna, Lorenzo ; Thiene, Gaetano ; Basso, Cristina ; Della Bella, Paolo
  • Assuntos: Adult ; Arrhythmias, Cardiac - epidemiology ; Arrhythmias, Cardiac - etiology ; Arrhythmias, Cardiac - therapy ; Female ; Humans ; Italy - epidemiology ; Male ; Middle Aged ; Myocarditis - complications ; Myocarditis - epidemiology ; Prospective Studies
  • É parte de: Journal of the American College of Cardiology, 2020-03, Vol.75 (9), p.1046-1057
  • Notas: ObjectType-Article-1
    SourceType-Scholarly Journals-1
    ObjectType-Feature-2
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  • Descrição: Ventricular arrhythmias (VAs) have never been systematically investigated in patients with myocarditis at different stages. 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). 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. 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). 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.
  • Editor: United States
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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