Abstract
Background. The incidence and burden of arrhythmias in myocarditis are under-reported. Objective. We aimed to assess the diagnostic yield and clinical impact of continuous arrhythmia monitoring (CAM) in patients with arrhythmic myocarditis. Methods. We enrolled consecutive adult patients (n = 104; 71% males, age 47 ± 11 year, mean LVEF 50 ± 13%) with biopsy-proven active myocarditis and de novo ventricular arrhythmias (VAs). All patients underwent prospective monitoring by both sequential 24-h Holter ECGs and CAM, including either ICD (n = 62; 60%) or loop recorder (n = 42; 40%). Results. By 3.7 ± 1.6 year follow up, 45 patients (43%) had VT, 67 (64%) NSVT and 102 (98%) premature ventricular complexes (PVC). As compared to the Holter ECG (average 9.5 exams per patient), CAM identified more patients with VA (VT: 45 vs. 4; NSVT: 64 vs. 45; both p < 0.001), more VA episodes (VT: 100 vs. 4%; NSVT: 91 vs. 12%) and earlier NSVT timing (median 6 vs. 24 months, p < 0.001). The extensive ICD implantation strategy was proven beneficial in 80% of the population. Histological signs of chronically active myocarditis (n = 73, 70%) and anteroseptal late gadolinium enhancement (n = 26, 25%) were significantly associated with the occurrence of VTs during follow up, even in the primary prevention subgroup. Conclusion. In patients with arrhythmic myocarditis, CAM allowed accurate arrhythmia detection and showed a considerable clinical impact.
Highlights
104 patients (71% males, mean age 47 ± 11 year) were enrolled, including those with arrhythmic presentation (n = 70) and those with arrhythmias detected during in-hospital telemonitoring (n = 34)
During FU, supraventricular arrhythmias (SVAs) episodes were documented in 27 patients (26%) including atrial fibrillation (AF) in 19 cases (18%)
In keeping with prior studies, we identified anteroseptal late gadolinium enhancement (LGE) [23,24,25,26] and histological signs suggesting chronic myocarditis [12,13] as factors associated with adverse arrhythmic outcomes, both in the whole cohort and in patients without malignant ventricular arrhythmias (VAs) onset
Summary
We aimed to assess the diagnostic yield and clinical impact of continuous arrhythmia monitoring (CAM) in patients with arrhythmic myocarditis. CAM may be useful to fill in relevant knowledge gaps on the incidence, type and burden of arrhythmias [4,5] This is clinically important since ventricular arrhythmias (VAs) and bradyarrhythmias (BAs) constitute life-threatening complications of myocarditis [6,7]. Indications for implantable cardioverter defibrillators (ICDs) are restricted in this population [5,6] and there is currently no experience about the use of implantable loop recorders (ILRs) as long-term monitoring devices. Med. 2021, 10, 5142 population [5,6] and there is currently no experience about the use of implantable loop recorders (ILRs) as long-term monitoring devices.
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