Chronic (or healed) myocarditis mimicking arrhythmogenic right ventricular dysplasia

Hofmann, Robin; Trappe, H.-J.; Klein, H O; Kemnitz, J

doi:10.1093/eurheartj/14.5.717

Cited by 37 publications

(10 citation statements)

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“…In conclusion, we believe that our patients were affected by two different diseases: 30% by an ARVD and 70% by a predominantly right-sided myocarditis simulating the clinical and instrumental characteristics of an ARVD, as already described in several case reports (27)(28)(29).…”

supporting

confidence: 73%

Histologic findings in patients with clinical and instrumental diagnosis of sporadic arrhythmogenic right ventricular dysplasia

Chimenti¹,

Pieroni²,

Maseri³

et al. 2004

Journal of the American College of Cardiology

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supporting

confidence: 73%

Histologic findings in patients with clinical and instrumental diagnosis of sporadic arrhythmogenic right ventricular dysplasia

Chimenti¹,

Pieroni²,

Maseri³

et al. 2004

Journal of the American College of Cardiology

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“…It may be regarded as chronic myocarditis because of the frequent ndings of lymphocyte in ltrates associated with myocyte death. In a case report of chronic myocarditis mimicking ARVC, a man experiencing ventricular tachycardia and myocarditis on repeated endomyocardial biopsies later developed ARVC (64). In 1 of our myocarditis cases (Case 1), small areas of the myocardium showed brofatty atrophy (2), suggesting an early stage of ARVC.…”

Section: Discussionmentioning

confidence: 77%

Subacute Bartonella Infection in Swedish Orienteers Succumbing to Sudden Unexpected Cardiac Death or Having Malignant Arrhythmias

Wesslén

Ehrenborg²,

Holmberg³

et al. 2001

Scandinavian Journal of Infectious Diseases

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During the period 1979-92, an increasing number of sudden unexpected cardiac deaths (SUCD) occurred in young, Swedish, male elite orienteers. Myocarditis was the most common diagnosis in the 16 victims, and in 4 cases was also associated with fatty infiltration mimicking arrhythmogenic right ventricular cardiomyopathy (ARVC). Tissues from autopsies of 5 orienteers were tested for Bartonella by PCR targeting the gltA (citrate-synthase) gene. The products were then sequenced. Antibodies to B. henselae, B. quintana and B. elizabethae were measured by indirect fluorescence antibody assay. Bartonella spp. DNA was detected in the hearts of 4 deceased orienteers, and in the lung of a fifth deceased case. The sequences were close to B. quintana in 2 cases and identical to B. henselae in 3. Four of these 5 cases, as well as 2 additional cases of elite orienteers with ARVC, indicated antibodies to Bartonella. It is suggested that Bartonella-induced silent subacute myocarditis, eventually leading to electric instability, caused the increased SUCD rate among the Swedish orienteers. It is further suggested that Bartonella infection may be a major pathogenetic factor in the development of ARVC-like disease. Although the mode of transmission is unknown, both zoonotic/vector-borne and parenteral person-to-person transmission may be involved.

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“…33,34 In the majority of our patients, the association between inflammatory changes and focal fibrosis suggested a longstanding disease with either a persistent or recurrent myocardial inflammatory process at different stages of healing. Although such a patchy fibrosis is frequently observed in patients with inflammatory cardiomyopathy, extensive and transmural areas of myocardial depletion with scarring are noted exceptionally, 35 thus explaining the absence of low-voltage areas.…”

Section: Abnormal Electroanatomic Voltage Mappingmentioning

confidence: 70%

Three-Dimensional Electroanatomic Voltage Mapping Increases Accuracy of Diagnosing Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia

et al. 2005

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Background— Three-dimensional electroanatomic voltage mapping offers the potential to identify low-voltage areas that correspond to regions of right ventricular (RV) myocardial loss and fibrofatty replacement in patients with arrhythmogenic RV cardiomyopathy/dysplasia (ARVC/D). Methods and Results— Thirty-one consecutive patients (22 men and 9 women; mean age, 30.8±7 years) who fulfilled the criteria of the Task Force of the European Society of Cardiology and International Society and Federation of Cardiology (ESC/ISFC) for ARVC/D diagnosis after noninvasive clinical evaluation underwent further invasive study including RV electroanatomic voltage mapping and endomyocardial biopsy (EMB) to validate the diagnosis. Multiple RV endocardial, bipolar electrograms (175±23) were sampled during sinus rhythm. Twenty patients (group A; 65%) had an abnormal RV electroanatomic voltage mapping showing ≥1 area (mean 2.25±0.7) with low-voltage values (bipolar electrogram amplitude <0.5 mV), surrounded by a border zone (0.5 to 1.5 mV) that transitioned into normal myocardium (>1.5 mV). Low-voltage electrograms appeared fractionated with significantly prolonged duration and delayed activation. In 11 patients (group B; 35%), electroanatomic voltage mapping was normal, with preserved electrogram voltage (4.4±0.7 mV) and duration (37.2±0.9 ms) throughout the RV. Low-voltage areas in patients from group A corresponded to echocardiographic/angiographic RV wall motion abnormalities and were significantly associated with myocyte loss and fibrofatty replacement at EMB ( P <0.0001) and familial ARVC/D ( P <0.0001). Patients from group B had sporadic disease and histopathological evidence of inflammatory cardiomyopathy ( P <0.0001). During the time interval from onset of symptoms to the invasive study, 11 patients (55%) with electroanatomic low-voltage regions received an implantable cardioverter/defibrillator because of life-threatening ventricular arrhythmias, whereas all but 1 patient with a normal voltage map remained stable on antiarrhythmic drug therapy ( P =0.02). Conclusions— Three-dimensional electroanatomic voltage mapping enhanced accuracy for diagnosing ARVC/D (1) by demonstrating low-voltage areas that were associated with fibrofatty myocardial replacement and (2) by identifying a subset of patients who fulfilled ESC/ISFC Task Force diagnostic criteria but showed a preserved electrogram voltage, an inflammatory cardiomyopathy mimicking ARVC/D, and a better arrhythmic outcome.

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Chronic (or healed) myocarditis mimicking arrhythmogenic right ventricular dysplasia

Cited by 37 publications

References 0 publications

Histologic findings in patients with clinical and instrumental diagnosis of sporadic arrhythmogenic right ventricular dysplasia

Histologic findings in patients with clinical and instrumental diagnosis of sporadic arrhythmogenic right ventricular dysplasia

Subacute Bartonella Infection in Swedish Orienteers Succumbing to Sudden Unexpected Cardiac Death or Having Malignant Arrhythmias

Three-Dimensional Electroanatomic Voltage Mapping Increases Accuracy of Diagnosing Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia

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