Assessment of patients presenting with life-threatening ventricular arrhythmias and suspected myocarditis: The key role of endomyocardial biopsy.
Adult
Biopsy
/ methods
Electrocardiography, Ambulatory
/ methods
Female
Follow-Up Studies
Humans
Imaging, Three-Dimensional
/ methods
Incidence
Italy
/ epidemiology
Magnetic Resonance Imaging, Cine
/ methods
Male
Myocarditis
/ diagnosis
Myocardium
/ pathology
Prospective Studies
Risk Assessment
/ methods
Risk Factors
Survival Rate
/ trends
Tachycardia, Ventricular
/ diagnosis
3D electroanatomic mapping
Endomyocardial biopsy
Myocardial fibrosis
Myocarditis
Personalized medicine
Replacement myocardial fibrosis
Ventricular arrhythmias
Journal
Heart rhythm
ISSN: 1556-3871
Titre abrégé: Heart Rhythm
Pays: United States
ID NLM: 101200317
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
received:
25
04
2020
revised:
03
01
2021
accepted:
19
01
2021
pubmed:
1
2
2021
medline:
11
1
2022
entrez:
31
1
2021
Statut:
ppublish
Résumé
Life-threatening ventricular tachyarrhythmias (VAs) represent a significant cause of death in myocarditis. The purpose of this study was to identify predictors of sustained VAs in patients with myocarditis and ventricular phenotype diagnosed by workflow including endomyocardial biopsy (EMB) guided by 3D electroanatomic mapping (3D-EAM). We prospectively enrolled patients with suspected myocarditis and VAs, undergoing cardiac magnetic resonance imaging, coronary angiography, 3D-EAM, and EMB guided by 3D-EAM. At follow-up, sustained VAs were detected by device interrogation and 24-hour electrocardiographic Holter monitoring. We enrolled 54 consecutive patients (mean age 41 ± 14 years; 32(59%) men) with normal ventricular function; left ventricular and right ventricular (RV) late gadolinium enhancement was present, respectively, in 21 (46%) and 6 (13%) of the 46 patients who underwent cardiac magnetic resonance. In 31 patients, the histological diagnosis was myocarditis, while in 14 patients, focal replacement myocardial fibrosis (FRMF); in 9 patients, specimens were inadequate (diagnostic yield of EMB 83%). 3D-EAM showed a larger endocardial scar area for both ventricles in myocarditis than in FRMF (RV bipolar mean scar area 22 ± 16 cm Our data highlight the need for 3D-EAM-guided EMB in apparently healthy young patients with suspected myocarditis and VAs.
Sections du résumé
BACKGROUND
Life-threatening ventricular tachyarrhythmias (VAs) represent a significant cause of death in myocarditis.
OBJECTIVE
The purpose of this study was to identify predictors of sustained VAs in patients with myocarditis and ventricular phenotype diagnosed by workflow including endomyocardial biopsy (EMB) guided by 3D electroanatomic mapping (3D-EAM).
METHODS
We prospectively enrolled patients with suspected myocarditis and VAs, undergoing cardiac magnetic resonance imaging, coronary angiography, 3D-EAM, and EMB guided by 3D-EAM. At follow-up, sustained VAs were detected by device interrogation and 24-hour electrocardiographic Holter monitoring.
RESULTS
We enrolled 54 consecutive patients (mean age 41 ± 14 years; 32(59%) men) with normal ventricular function; left ventricular and right ventricular (RV) late gadolinium enhancement was present, respectively, in 21 (46%) and 6 (13%) of the 46 patients who underwent cardiac magnetic resonance. In 31 patients, the histological diagnosis was myocarditis, while in 14 patients, focal replacement myocardial fibrosis (FRMF); in 9 patients, specimens were inadequate (diagnostic yield of EMB 83%). 3D-EAM showed a larger endocardial scar area for both ventricles in myocarditis than in FRMF (RV bipolar mean scar area 22 ± 16 cm
CONCLUSION
Our data highlight the need for 3D-EAM-guided EMB in apparently healthy young patients with suspected myocarditis and VAs.
Identifiants
pubmed: 33516948
pii: S1547-5271(21)00098-9
doi: 10.1016/j.hrthm.2021.01.025
pii:
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
907-915Informations de copyright
Copyright © 2021 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.