Objectives: This study sought to assess long-term arrhythmic risk in patients with myocarditis who received an implantable cardioverter-defibrillator (ICD). Background: The arrhythmic risk of patients with myocarditis overtime remains poorly known. Methods: The study enrolled 56 patients with biopsy-proven myocarditis who received an ICD for either primary (57%) or secondary prevention (43%) according to current guidelines. Clinical characteristics, biopsy findings, electrophysiological data from endocardial 3-dimensional electroanatomic voltage mapping, and device interrogation data were analyzed to detect arrhythmic events overtime. Coronary angiography excluded significant coronary artery disease in all patients. Results: At a mean follow-up of 74 ± 60 months (median 65 months), 25 (45%) patients had major ventricular arrhythmias treated by ICD intervention (76% being terminated by ICD shock and 24% by antitachyarrhythmia burst pacing). At multivariable analysis, the presence of sustained ventricular tachycardia on admission (hazard ratio: 13.0; 95% confidence interval: 2.0 to 35.0; p = 0.032) and the extension of the areas of low potentials at the bipolar endocardial mapping (hazard ratio: 1.19; 95% confidence interval: 1.04 to 1.37; p = 0.013) were the only independent predictors of appropriate ICD interventions. A cutoff value of 10% of abnormal bipolar area at electroanatomical ventricular mapping discriminated patients with appropriate ICD interventions with a sensitivity of 89% and a specificity of 85%. Conclusions: The study demonstrates that the prevalence of life-threatening ventricular arrhythmias in patients with myocarditis receiving an ICD according to current guidelines is high and the arrhythmic risk persists late overtime. Electroanatomical ventricular mapping may be a useful tool to identify patients at greater arrhythmic risk.

Pelargonio, G., Pinnacchio, G., Narducci, M. L., Pieroni, M., Perna, F., Bencardino, G., Comerci, G., Dello Russo, A., Casella, M., Bartoletti, S., Russo, E., Crea, F., Long-Term Arrhythmic Risk Assessment in Biopsy-Proven Myocarditis, <<JACC. CLINICAL ELECTROPHYSIOLOGY>>, 2020; 6 (5): 574-582. [doi:10.1016/j.jacep.2019.12.010] [http://hdl.handle.net/10807/166650]

Long-Term Arrhythmic Risk Assessment in Biopsy-Proven Myocarditis

Pelargonio, G.;Pinnacchio, G.;Narducci, M. L.;Pieroni, M.;Perna, F.;Bencardino, G.;Comerci, G.;Dello Russo, A.;Casella, M.;Bartoletti, S.;Crea, F.
2020

Abstract

Objectives: This study sought to assess long-term arrhythmic risk in patients with myocarditis who received an implantable cardioverter-defibrillator (ICD). Background: The arrhythmic risk of patients with myocarditis overtime remains poorly known. Methods: The study enrolled 56 patients with biopsy-proven myocarditis who received an ICD for either primary (57%) or secondary prevention (43%) according to current guidelines. Clinical characteristics, biopsy findings, electrophysiological data from endocardial 3-dimensional electroanatomic voltage mapping, and device interrogation data were analyzed to detect arrhythmic events overtime. Coronary angiography excluded significant coronary artery disease in all patients. Results: At a mean follow-up of 74 ± 60 months (median 65 months), 25 (45%) patients had major ventricular arrhythmias treated by ICD intervention (76% being terminated by ICD shock and 24% by antitachyarrhythmia burst pacing). At multivariable analysis, the presence of sustained ventricular tachycardia on admission (hazard ratio: 13.0; 95% confidence interval: 2.0 to 35.0; p = 0.032) and the extension of the areas of low potentials at the bipolar endocardial mapping (hazard ratio: 1.19; 95% confidence interval: 1.04 to 1.37; p = 0.013) were the only independent predictors of appropriate ICD interventions. A cutoff value of 10% of abnormal bipolar area at electroanatomical ventricular mapping discriminated patients with appropriate ICD interventions with a sensitivity of 89% and a specificity of 85%. Conclusions: The study demonstrates that the prevalence of life-threatening ventricular arrhythmias in patients with myocarditis receiving an ICD according to current guidelines is high and the arrhythmic risk persists late overtime. Electroanatomical ventricular mapping may be a useful tool to identify patients at greater arrhythmic risk.
Inglese
Pelargonio, G., Pinnacchio, G., Narducci, M. L., Pieroni, M., Perna, F., Bencardino, G., Comerci, G., Dello Russo, A., Casella, M., Bartoletti, S., Russo, E., Crea, F., Long-Term Arrhythmic Risk Assessment in Biopsy-Proven Myocarditis, <<JACC. CLINICAL ELECTROPHYSIOLOGY>>, 2020; 6 (5): 574-582. [doi:10.1016/j.jacep.2019.12.010] [http://hdl.handle.net/10807/166650]
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10807/166650
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