Author + information
- Received May 5, 2020
- Revision received May 9, 2020
- Accepted May 9, 2020
- Published online June 24, 2020.
- Giovanni Peretto, MDa,b,∗ (, )
- Simone Sala, MDa,
- Giacomo De Luca, MDb,c,
- Renzo Marcolongo, MDd,
- Corrado Campochiaro, MDc,
- Silvia Sartorelli, MDc,
- Moreno Tresoldi, MDe,
- Luca Foppoli, MEf,
- Anna Palmisano, MDb,g,
- Antonio Esposito, MDb,g,
- Francesco De Cobelli, MDb,g,
- Stefania Rizzo, MDh,
- Gaetano Thiene, MDh,
- Cristina Basso, MDh,
- Lorenzo Dagna, MDb,c,
- Alida Linda Patrizia Caforio, MD, PhDi and
- Paolo Della Bella, MDa,b
- aDepartment of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- bSan Raffaele Vita-Salute University, Milan, Italy
- cUnit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
- dDepartment of Medicine, Haematology and Clinical Immunology, Padua University, Padua, Italy
- eUnit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- fIRCCS San Raffaele Hospital and Vita-Salute University, Milan, Italy
- gExperimental Imaging Center, Radiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- hDepartment of Cardiac Thoracic Vascular Sciences and Public Health, Cardiovascular Pathology, Padua University, Padua, Italy
- iDepartment of Cardiac Thoracic Vascular Sciences and Public Health, Cardiology, Padua University, Padua, Italy
- ↵∗Address for correspondence:
Dr. Giovanni Peretto, Vita-Salute University and San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy.
Objectives This study sought to investigate the effects of immunosuppression on arrhythmic myocarditis.
Background The effects of immunosuppressive therapy (IST) on ventricular arrhythmia (VA) have not been reported in patients with immune-mediated biopsy-proven myocarditis. Furthermore, myocarditis arrhythmic risk is still unpredictable.
Methods We enrolled 255 patients with biopsy-proven virus-negative myocarditis and VA (major: ventricular fibrillation, ventricular tachycardia; minor: nonsustained ventricular tachycardia, Lown grade ≥2 premature ventral complexes) at presentation. Serum cardiac autoantibodies (antiheart antibodies, anti–intercalated disk autoantibodies [AIDA]) were detected by a standardized indirect immunofluorescence technique. Whenever accepted and noncontraindicated, IST was started. Control individuals (IST−) were chosen after 1:1 matching to IST+ patients by age, sex, ethnicity, left ventricular ejection fraction, VA type, and treatment.
Results A total of 58 matched patient couples (age 42 ± 13 years; 67% male) were analyzed in the main study cohort. IST duration was 12 ± 1 months. By the 24-month prospective follow-up, major VA occurred in 6 IST+ versus 10 IST− patients (p = 0.42), with no episodes following IST termination. As compared to IST− patients, IST+ patients showed a significant reduction in minor VA burden, as well as improvement in clinical, laboratory, and imaging findings (all p < 0.05). Major VA onset and positive AIDA status were independently associated with major VA at follow-up (hazard ratio [HR]: 14.2; 95% confidence interval [CI]: 2.9 to 68.7 and HR: 8.0; 95% CI: 2.6 to 25.2, respectively; both p < 0.001). Furthermore, in the whole study population (N = 255), IST was independently associated with protection from major VA (HR: 0.3; 95% CI: 0.2 to 0.7; p = 0.01) at 38 ± 21 months of follow-up.
Conclusions In patients with immune-mediated virus-negative myocarditis presenting with VA, IST is associated with positive effects on minor VA and nonarrhythmic endpoints. Short-term effects are limited on major VA, which were independently associated with major VA onset and positive AIDA.
- cardiac autoantibodies
- endomyocardial biopsy
- immunosuppressive therapy
- 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 May 5, 2020.
- Revision received May 9, 2020.
- Accepted May 9, 2020.
- 2020 American College of Cardiology Foundation
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