Focal Parvovirus B19 Myocarditis in a Patient with Brugada Syndrome

Abstract

The Brugada syndrome is characterized by a distinct ECG pattern consisting of ST segment elevation in the right precordial leads and right bundle branch block, a propensity for life-threatening arrhythmias, and an apparently structurally normal heart. The authors describe the case of a patient with an aborted sudden cardiac death and the typical ECG signs of Brugada syndrome. Nevertheless, magnetic resonance imaging displayed signal enhancement in the left ventricular myocardium. Additionally, histologic examination, in-situ hybridization, and PCR revealed evidence of a locally restricted inflammation due to parvovirus B19. Brugada syndrome is regarded as a primary electrical disease due to dysfunction of distinctive ion channels, but focal myocarditis may serve as a trigger for ventricular arrhythmias in this patient. Further morphologic studies will be helpful to establish the possible role of structural changes in the pathophysiology of this syndrome.

Cardiac Histological Substrate in Patients With Clinical Phenotype of Brugada Syndrome

“…The knowledge that myocarditis may mimic the BS is not novel 22 ; nevertheless, the present study indicates that it can be recognized in as much as 77% of an unselected population that presents with the clinical phenotype of BS and sustained The major reduction in current density obtained with the R367H mutation did not allow further characterization of current kinetics.…”

Human Parvoviruses

“…B19V infection, detected most often by serological evidence of recent infection and sometimes by the detection of viral genomes in cardiac tissue, has been reported in myocarditis in the fetus (see the section on hydrops below), in infancy, during childhood, and among young adults (174,176,(832)(833)(834)(835)(836)(837)(838)(839)(840). In one center's series of 19 pediatric patients, the presenting symptoms were upper respiratory and gastrointestinal symptoms; all infected children had ventricular dysfunction, 2 died, and 3 required heart transplantation (176).…”

Myocarditis and cardiac channelopathies: A deadly association?

“…reported the case of a 34-year-old patient with resuscitated sudden death due to documented acute myocarditis and an ECG suggesting Brugada syndrome [3]. Likewise, Frustaci et al found pathological findings consistent with myocarditis in more than 75% of a cohort of patients with symptomatic Brugada syndrome [4].…”

“…Echocardiographic assessment of acute hemodynamic response during optimization of resynchronization pace-maker using different pacing modalities and atrioventricular delays☆ In patients with the manifested heart insufficiency and bundle branch block with prolonged duration of QRS complex, cardiac resynchronization therapy (CRT) with its dyssynchrony reduction leads to symptom reduction, life quality improvement and better prognosis [1][2][3]. However in some number of patients this therapy does not improve symptoms and signs of the disease [4,5].…”