Highlights
- •About 30% of patients with suspected myocarditis undergoing endomyocardial biopsy receive an ICD during long-term follow.
- •Patients with biopsy-proven myocardial inflammation are at increased risk to receive an ICD for primary prevention.
- •Half of all ICD recipients experience ventricular arrhythmias requiring ICD therapy.
Abstract
Background
Inflammatory heart disease is known to be associated with ventricular arrhythmias
(VA) and impaired ventricular function at presentation or during follow-up. We aimed
to investigate the need for implanted cardioverter defibrillator (ICD) due to ventricular
dysfunction and occurrence of VA during long-term follow-up in patients admitted with
suspected myocarditis.
Methods
Between 2000 and 2016, 191 patients (age 43 ± 13 years, 71% male, mean left ventricular
ejection fraction (LVEF) 33 ± 15%) with clinically suspected myocarditis, who underwent
endomyocardial biopsies (EMB), were prospectively enrolled and followed up in 6-months-intervals
(median follow-up was 83 (49–156) months). The primary endpoint was deterioration
of cardiac function (LVEF ≤ 35%) or occurrence of VA leading to ICD implantation.
Results
According to EMB results, patients were stratified in three diagnostic groups: acute
myocarditis (5%), chronic myocarditis (50%) and dilated cardiomyopathy (DCM) (45%).
An ICD implantation was performed in 58 patients (30%, n = 38 for primary prevention).
Besides LVEF at baseline, chronic myocardial inflammation was the only independent
predictor of ICD implantation for primary prevention (hazard ratio 2.48 (95% confidence
interval 1.02–5.5); p = 0.045). VA requiring ICD therapy occurred in 29 of 58 patients
(50%) after a median of 14 (2–37) months without a significant difference between
presence and absence of myocardial inflammation.
Conclusions
Nearly one third of patients with suspected myocarditis require an ICD due to impaired
LVEF or occurrence of VA. Half of these patients experienced VA with adequate ICD
therapy.
Abbreviations:
CI (confidence interval), CRT (cardiac resynchronization therapy), DCM (dilated cardiomyopathy), EMB (endomyocardial biopsies), HF (heart failure), HTx (heart transplantation), HR (hazard ratio), ICD (implanted cardioverter defibrillator), LVEF (left ventricular ejection fraction), SCD (sudden cardiac death), VA (ventricular arrhythmia), VT (ventricular tachycardia), VF (ventricular fibrillation)Keywords
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Article Info
Publication History
Published online: August 08, 2018
Accepted:
July 30,
2018
Received in revised form:
July 9,
2018
Received:
March 20,
2018
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
