Author + information
- Received July 15, 2019
- Revision received December 9, 2019
- Accepted December 12, 2019
- Published online February 26, 2020.
- Gemma Pelargonio, MD, PhDa,b,
- Gaetano Pinnacchio, MDa,
- Maria Lucia Narducci, MD, PhDa,∗ (, )
- Maurizio Pieroni, MD, PhDc,
- Francesco Perna, MD, PhDa,
- Gianluigi Bencardino, MD, PhDa,
- Gianluca Comerci, MDa,
- Antonio Dello Russo, MD, PhDd,
- Michela Casella, MD, PhDe,
- Stefano Bartoletti, MDa,
- Eleonora Russo, MD, PhDf and
- Filippo Crea, MD, PhDa,b
- aDepartment of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- bInstitute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy
- cCardiovascular Department, San Donato Hospital, Arezzo, Italy
- dClinica di Cardiologia e Aritmologia Universitá Politecnica delle Marche, Ancona, Italy
- eHeart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
- fDepartment of Cardiovascular Disease, Division of Cardiology, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
- ↵∗Address for correspondence:
Dr. Maria Lucia Narducci, Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome, Largo A. Gemelli, 8 - 00168 Rome, Italy.
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; 95% confidence interval: 2 to 35; 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.
- implantable cardioverter-defibrillator
- innovative biotechnology
- personalized medicine
- sudden cardiac death
- ventricular arrhythmias
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received July 15, 2019.
- Revision received December 9, 2019.
- Accepted December 12, 2019.
- 2020 American College of Cardiology Foundation
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