Programmed ventricular stimulation in patients with active vs previous arrhythmic myocarditis.
Introduction: No studies so far addressed the role of invasive programmed ventricular stimulation (PVS) in myocarditis patient's arrhythmic risk stratification. Methods and Results: We present a single‐center prospective study on 96 consecutive adult patients (44 ± 13 years, 70.1% males) with myocar...
| Publicado en: | Journal of Cardiovascular Electrophysiology Vol. 31; no. 3; pp. 692 - 702 |
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| Autores principales: | , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Mar2020
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=142181998&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 142181998 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10453873 GSB jtl: Journal of Cardiovascular Electrophysiology issn: 10453873 maglogo: Y pubinfo: dt: Mar2020 vid: 31 iid: 3 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 142181998 142181998 145782561 142181998 10.1111/jce.14374 142181998 ppf: 692 ppct: 10 formats: fmt: – @attributes: type: T – @attributes: type: C – @attributes: type: P tig: atl: Programmed ventricular stimulation in patients with active vs previous arrhythmic myocarditis. aug: au: Peretto, Giovanni Sala, Simone Basso, Cristina Della Bella, Paolo affil: Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital and Vita‐Salute University, Milan, Italy sug: subj: Myocardial Diseases Arrhythmia, Ventricular Electrophysiology Heart Ventricle Human Prospective Studies Middle Age Male Female Confidence Intervals Descriptive Statistics Middle Aged: 45-64 years Male Female ab: Introduction: No studies so far addressed the role of invasive programmed ventricular stimulation (PVS) in myocarditis patient's arrhythmic risk stratification. Methods and Results: We present a single‐center prospective study on 96 consecutive adult patients (44 ± 13 years, 70.1% males) with myocarditis and ventricular arrhythmias (VA) at index hospitalization. Depending on baseline endomyocardial biopsy (EMB) and cardiac magnetic resonance, patients were divided into two groups: active (A) vs nonactive (NA) myocarditis. All of the patients underwent PVS at index hospitalization. Medical treatment and implantable cardioverter‐defibrillator (ICD) implantation were clinically‐driven. Malignant VA episodes (MVA = ventricular tachycardias [VT], ventricular fibrillation [VF], appropriate ICD therapy) were evaluated at 54 ± 18 months follow‐up (FU). Patients who underwent VT ablation or with myocarditis recurrence (n = 9) were excluded. Of 87 patients, 41 (47.2%) were in group A. PVS was positive in 32 cases (36.8%), 16 A vs 16 NA (P = NS), with no associations with VA type at presentation. Before discharge, 55 patients (63.2%) underwent ICD implant. In FU, MVA occurred in 27 patients (31.0%), 13 A vs 14 NA (P = NS), 18 PVS+ vs 9 PVS‐ (P <.001). The association between PVS result and FU MVA was maximal in group NA (high rule‐out performance with negative predictive value = 90.0%, P <.001) and minimal in group A (low rule‐in performance with PPV = 43.8%, P =.302). In the whole population, three independent factors for major VA were identified: major arrhythmic onset by sustained VT or VF (HR 2.8, 95% CI, 1.0‐7.4, P =.042), presence of fibrosis at EMB (HR 5.8, 95% CI, 1.1‐30.0, P =.038), and PVS positivity (HR 4.2, 95% CI, 1.7‐10.7, P =.003). Conclusion: In myocarditis patients presenting with VA, PVS is associated with FU MVA in NA patients, but not in A ones. Overall, risk stratification of arrhythmic myocardits is still complex and multifactorial. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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