Abstract 13292: Bradycardia as a Manifestation of Chikungunya Myocarditis. A New Threat to America

Abstract

Background: Chikungunya fever is an arthropod-borne disease that has caused millions of infections globally. Local transmission has been reported in the United States. There are very few published reports concerning the cardiac complications in general and bradycardia in particular. Objective: To investigate the occurrence of myocarditis and bradycardia in patients with Chikungunya fever. Methods: Prospective multicenter observational studio of 287 patients with a chikungunya infection during a Venezuelan outbreak. Clinical evaluation, X Ray, ECG, Echocardiogram, Holter, laboratory including virological evaluation, cardiac biomarkers, and cardiac MRI procedures were performed. Results: Of the 287 patients examined, 117 were male with a mean age of 59 ± 8; 277 patients presented with fever and polyarthralgia and 91 developed palpitations. Arrhythmias occurred in 45% of cases; they included bradiarrhytmias (33%), atrial and ventricular ectopic beats and tachyarrhythmia’s in which atrial fibrillation was observed in 19 cases. There were also ectopic atrial tachycardia and non-sustained ventricular tachycardia, conduction disturbances and 3 cases of sudden death. Conclusion: Physicians should be aware of the possibility of manifest or silent myocarditis in almost half of patients with Chikungunya disease. In a proper epidemiological context, the triad of fever, polyarthralgia and new arrhythmia, including bradiarrhytmias suggests Chikungunya myocarditis.