Inflammation as a Predictor of Recurrent Ventricular Tachycardia After Ablation in Patients With Myocarditis

Peretto, Giovanni; Sala, Simone; Basso, Cristina; Rizzo, Stefania; Radinovic, Andrea; Frontera, Antonio; Limite, Luca Rosario; Paglino, Gabriele; Bisceglia, Caterina; Luca, Giacomo De; Campochiaro, Corrado; Sartorelli, Silvia; Palmisano, Anna; Esposito, Antonio; Busnardo, Elena; Villatore, Andrea; Baratto, Francesca; Cireddu, Manuela; Marzi, Alessandra; D’Angelo, Giuseppe; Gulletta, Simone; Vergara, Pasquale; Cobelli, Francesco De; Dagna, Lorenzo; Mazzone, Patrizio; Bella, Paolo Della

doi:10.1016/j.jacc.2020.08.012

Cited by 42 publications

(35 citation statements)

References 35 publications

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“…It should be mentioned that, reflecting the heterogeneity of VA, the reported procedure strategies widely ranged from pace mapping to activation map and entrainment. Overall, in line with prior experiences on nonischemic cardiomyopathies, 10 VA ablation sites were concordant with LGE areas. Given the frequently reported septal involvement, and consistent heterogeneity in VA morphologies, bipolar ablation may be a valuable next‐step option, to address deep midwall substrates in LVNC 11 .…”

supporting

confidence: 85%

Arrhythmic risk stratification in left ventricular noncompaction

Peretto

2021

Cardiovasc electrophysiol

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supporting

confidence: 85%

Arrhythmic risk stratification in left ventricular noncompaction

Peretto

2021

Cardiovasc electrophysiol

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“…Conversely, the CAM accuracy in detecting PVCs was remarkably lower compared to Holter ECG, which allowed precise PVC quantification over time [10]. As a relevant guidance for the planning of catheter ablation strategies, the clinical VA morphology requires documentation by 12-lead ECG recording [10,16]. Recently, VA characterization by ECG has also been proposed as a tool to assess the myocardial inflammatory stage [17,18] and identify the suitable candidates for VT ablation [16].…”

Section: Diagnostic Accuracy For Vamentioning

confidence: 99%

“…As a relevant guidance for the planning of catheter ablation strategies, the clinical VA morphology requires documentation by 12-lead ECG recording [10,16]. Recently, VA characterization by ECG has also been proposed as a tool to assess the myocardial inflammatory stage [17,18] and identify the suitable candidates for VT ablation [16]. In keeping with myocarditis healing, CAM recordings documented a progressive reduction in VA cycle length variability during follow-up, in parallel with a prevalence of monomorphic PVC by Holter ECG (Figure S2).…”

Section: Diagnostic Accuracy For Vamentioning

confidence: 99%

“…As for the device choice, in our experience, dual-chamber ICDs are advisable to minimize the risk of inappropriate shocks by single-lead devices. In turn, since scar-related VA may even occur during the post-inflammatory stage of myocarditis [16,17], the use of wearable cardioverter defibrillators could be undermined by the unpredictable optimal timing for device withdrawal: while life-vests are currently recommended as a bridge for decision making in acute myocarditis [5,30], S-ICDs may constitute a valuable alternative in the chronic setting. Finally, because of a combination of high diagnostic accuracy, general acceptance among patients (Table S4) and CMR feasibility [31,32], we suggest the widespread use of ILRs as optimal diagnostic tools for the remaining low-risk patients with arrhythmic myocarditis [33,34].…”

Section: Device Indication and Choicementioning

confidence: 99%

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Continuous Electrical Monitoring in Patients with Arrhythmic Myocarditis: Insights from a Referral Center

Peretto

Mazzone

Paglino

et al. 2021

JCM

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Background. The incidence and burden of arrhythmias in myocarditis are under-reported. Objective. We aimed to assess the diagnostic yield and clinical impact of continuous arrhythmia monitoring (CAM) in patients with arrhythmic myocarditis. Methods. We enrolled consecutive adult patients (n = 104; 71% males, age 47 ± 11 year, mean LVEF 50 ± 13%) with biopsy-proven active myocarditis and de novo ventricular arrhythmias (VAs). All patients underwent prospective monitoring by both sequential 24-h Holter ECGs and CAM, including either ICD (n = 62; 60%) or loop recorder (n = 42; 40%). Results. By 3.7 ± 1.6 year follow up, 45 patients (43%) had VT, 67 (64%) NSVT and 102 (98%) premature ventricular complexes (PVC). As compared to the Holter ECG (average 9.5 exams per patient), CAM identified more patients with VA (VT: 45 vs. 4; NSVT: 64 vs. 45; both p < 0.001), more VA episodes (VT: 100 vs. 4%; NSVT: 91 vs. 12%) and earlier NSVT timing (median 6 vs. 24 months, p < 0.001). The extensive ICD implantation strategy was proven beneficial in 80% of the population. Histological signs of chronically active myocarditis (n = 73, 70%) and anteroseptal late gadolinium enhancement (n = 26, 25%) were significantly associated with the occurrence of VTs during follow up, even in the primary prevention subgroup. Conclusion. In patients with arrhythmic myocarditis, CAM allowed accurate arrhythmia detection and showed a considerable clinical impact.

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“…Heart involvement is frequent and is a major cause of mortality in systemic sclerosis (SSc), being responsible for up to 30% of disease-related deaths (1)(2)(3). Heart involvement has a variable clinical presentation: at early stages most patients are asymptomatic, but some go on to develop arrhythmias, dyspnea, chest pain, and heart failure (HF) (1,(4)(5)(6)(7)(8)(9). In comparison to other inflammatory myocardial disease, myocardial fibrosis is usually considered the immunopathologic hallmark of SSc heart disease.…”

Section: Introductionmentioning

confidence: 99%

Interleukin-1 and Systemic Sclerosis: Getting to the Heart of Cardiac Involvement

et al. 2021

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Systemic sclerosis (SSc) is rare, severe connective tissue disease characterized by endothelial and vascular damage, immune activation, and resulting in inflammation and fibrosis of skin and internal organs, including the heart. SSc is associated with high morbidity and mortality. Cardiac involvement is frequent in SSc patients, even though often asymptomatic at early stages, and represents one of the major causes of SSc-related mortality. Heart involvement has a variable clinical presentation, and its pathogenesis is not completely understood. Myocardial fibrosis is traditionally considered the immunopathologic hallmark of heart involvement in SSc. This unique histological feature is paralleled by distinctive clinical and prognostic features. The so-called “vascular hypothesis” represents the most credited hypothesis to explain myocardial fibrosis. More recently, the prominent role of an inflammatory myocardial process has been identified as a cardinal event in the evolution to fibrosis, thus also delineating an “inflammation-driven pathway to fibrosis”. The pro-inflammatory cytokine interleukin (IL)-1 has an apical and cardinal role in the myocardial inflammatory cascade and in cardiac dysfunction. The primary aim of this perspective article is: to present the emerging evidence on the role of IL-1 and inflammasome in both SSc and heart inflammation, to review the complex interplay between cellular metabolism and inflammasome activation, and to discuss the rationale for targeted inhibition of IL-1 for the treatment of SSc-heart involvement, providing preliminary experimental and clinical data to support this hypothesis.

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Inflammation as a Predictor of Recurrent Ventricular Tachycardia After Ablation in Patients With Myocarditis

Cited by 42 publications

References 35 publications

Arrhythmic risk stratification in left ventricular noncompaction

Arrhythmic risk stratification in left ventricular noncompaction

Continuous Electrical Monitoring in Patients with Arrhythmic Myocarditis: Insights from a Referral Center

Interleukin-1 and Systemic Sclerosis: Getting to the Heart of Cardiac Involvement

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