Arrhythmias in myocarditis: State of the art

Peretto, Giovanni; Sala, Simone; Rizzo, Stefania; Luca, Giacomo De; Campochiaro, Corrado; Sartorelli, Silvia; Benedetti, Giulia; Palmisano, Anna; Esposito, Antonio; Tresoldi, Moreno; Thiene, Gaetano; Basso, Cristina; Bella, Paolo Della

doi:10.1016/j.hrthm.2018.11.024

Cited by 185 publications

(174 citation statements)

References 51 publications

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“…Myocarditis is an inflammatory disease of the myocardium that has a wide variety of clinical presentations and whose clinical course is poorly understood. Acute myocarditis is associated with arrhythmias in about one-quarter of patients; one-third of the arrhythmias are either ventricular tachycardia (VT) or ventricular fibrillation (VF) [1,2].…”

Section: Introductionmentioning

confidence: 99%

High Risk of Sustained Ventricular Arrhythmia Recurrence After Acute Myocarditis

Rosier¹,

Zouaghi

Barré

et al. 2020

JCM

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Acute myocarditis is associated with cardiac arrhythmia in 25% of cases; a third of these arrhythmias are ventricular tachycardia (VT) or ventricular fibrillation (VF). The implantation of a cardiac defibrillator (ICD) following sustained ventricular arrhythmia remains controversial in these patients. We sought to assess the risk of major arrhythmic ventricular events (MAEs) over time in patients implanted with an ICD following sustained VT/VF in the acute phase of myocarditis compared to those implanted for VT/VF occurring on myocarditis sequelae. Our retrospective observational study included patients implanted with an ICD following VT/VF during acute myocarditis or VT/VF on myocarditis sequelae, from 2007 to 2017, in 15 French university hospitals. Over a median follow-up period of 3 years, MAE occurred in 11 (39%) patients of the acute myocarditis group and 24 (60%) patients of the myocarditis sequelae group. Kaplan–Meier MAE rate estimates at one and three years of follow-up were 19% and 45% in the acute group, and 43% and 64% in the sequelae group. Patients who experienced sustained ventricular arrhythmias during acute myocarditis had a very high risk of VT/VF recurrence during follow-up. These results show that the risk of MAE recurrence remains high after resolution of the acute episode.

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Section: Introductionmentioning

confidence: 99%

High Risk of Sustained Ventricular Arrhythmia Recurrence After Acute Myocarditis

Rosier¹,

Zouaghi

Barré

et al. 2020

JCM

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“…This is particularly relevant, since A and NA groups showed otherwise a wide overlap in baseline clinical features, including NT‐proBNP, LVEF, and LGE extension (Table 1). Even group A‐associated features like T‐troponin rise, ST‐segment abnormalities and pericardial effusion, although very common in acute myocarditis, 5 may be absent in the chronic active phase of the disease 14 . Similarly, although polymorphic VT/VF was significantly more common in active myocarditis, more than 50% group A patients (23/41) had monomorphic VT at presentation, like NA cases, and undistinguishable PVC burden.…”

Section: Discussionmentioning

confidence: 99%

Programmed ventricular stimulation in patients with active vs previous arrhythmic myocarditis

Peretto

Sala

Basso

et al. 2020

Cardiovasc electrophysiol

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Introduction No studies so far addressed the role of invasive programmed ventricular stimulation (PVS) in myocarditis patient's arrhythmic risk stratification. Methods and Results We present a single‐center prospective study on 96 consecutive adult patients (44 ± 13 years, 70.1% males) with myocarditis and ventricular arrhythmias (VA) at index hospitalization. Depending on baseline endomyocardial biopsy (EMB) and cardiac magnetic resonance, patients were divided into two groups: active (A) vs nonactive (NA) myocarditis. All of the patients underwent PVS at index hospitalization. Medical treatment and implantable cardioverter‐defibrillator (ICD) implantation were clinically‐driven. Malignant VA episodes (MVA = ventricular tachycardias [VT], ventricular fibrillation [VF], appropriate ICD therapy) were evaluated at 54 ± 18 months follow‐up (FU). Patients who underwent VT ablation or with myocarditis recurrence (n = 9) were excluded. Of 87 patients, 41 (47.2%) were in group A. PVS was positive in 32 cases (36.8%), 16 A vs 16 NA (P = NS), with no associations with VA type at presentation. Before discharge, 55 patients (63.2%) underwent ICD implant. In FU, MVA occurred in 27 patients (31.0%), 13 A vs 14 NA (P = NS), 18 PVS+ vs 9 PVS‐ (P < .001). The association between PVS result and FU MVA was maximal in group NA (high rule‐out performance with negative predictive value = 90.0%, P < .001) and minimal in group A (low rule‐in performance with PPV = 43.8%, P = .302). In the whole population, three independent factors for major VA were identified: major arrhythmic onset by sustained VT or VF (HR 2.8, 95% CI, 1.0‐7.4, P = .042), presence of fibrosis at EMB (HR 5.8, 95% CI, 1.1‐30.0, P = .038), and PVS positivity (HR 4.2, 95% CI, 1.7‐10.7, P = .003). Conclusion In myocarditis patients presenting with VA, PVS is associated with FU MVA in NA patients, but not in A ones. Overall, risk stratification of arrhythmic myocardits is still complex and multifactorial.

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“…However, again, this is not an unusual finding in viral cardiomyopathies. 26 Indeed, in their recent review and meta-analysis, Becker et al noted that "these findings underscore that ejection fraction should be regarded as a readily available measure of substrate burden, particularly in patients with ischemic cardiomyopathy, but its usage should be reconsidered in patients with [dilated cardiomyopathy]. Cohort studies show that most patients with sudden death in this patient group have only a moderately reduced ejection fraction (> 35%) and, as recently demonstrated by Halliday et al, that the presence of mid-wall LGE identified a subgroup of patients at increased risk for SCD."…”

Section: Dr Gimbel Exploresmentioning

confidence: 99%

“…While emerging as the reference noninvasive diagnostic standard, cardiac MRI is still a work in progress 29 and endomyocardial biopsy (EMB) remains the gold standard method for diagnosis. 20,26 Consideration might have been given to endomyocardial biopsy (EMB) prior to ICD implantation if a viral myocarditis was suspected. 20 The authors did highlight that the interpretation of the cardiac MRI image was "most consistent with a phenomenon of residual fibrosis from a past viral myocarditis."…”

Section: Dr Gimbel Exploresmentioning

confidence: 99%

Considering the Need to Expand the Indications for Wearable Defibrillator Therapy

Milan¹,

Klein²,

Gimbel³

et al. 2019

J Innov Cardiac Rhythm Manage.

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Arrhythmias in myocarditis: State of the art

Cited by 185 publications

References 51 publications

High Risk of Sustained Ventricular Arrhythmia Recurrence After Acute Myocarditis

High Risk of Sustained Ventricular Arrhythmia Recurrence After Acute Myocarditis

Programmed ventricular stimulation in patients with active vs previous arrhythmic myocarditis

Considering the Need to Expand the Indications for Wearable Defibrillator Therapy

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