High Risk of Sustained Ventricular Arrhythmia Recurrence After Acute Myocarditis.

L Rosier ,Amir Zouaghi,Bruno Degand,Samuel Chauveau,Marc Badoz,Jérémie Barraud,François Lesaffre,Yves Cottin,Rodrigue Garcia,Charles Guenancia,Vincent Probst,Valentin Barré,Romain Eschalier,Estelle Gandjbakhch,Jacques Mansourati,Antoine Noël,Nicolas Sadoul,Vincent Algalarrondo,Antoine Da Costa,Fabrice Extramiana,Marisa González Montero De Espinosa ,Raphaël P Martins ,Éloi Marijon ,Michaël Peyrol ,H Devilliers ,Grégoire Massoullié

doi:10.3390/jcm9030848

Abstract

Acute myocarditis is associated with cardiac arrhythmia in 25% of cases; a third of these arrhythmias are ventricular tachycardia (VT) or ventricular fibrillation (VF). The implantation of a cardiac defibrillator (ICD) following sustained ventricular arrhythmia remains controversial in these patients. We sought to assess the risk of major arrhythmic ventricular events (MAEs) over time in patients implanted with an ICD following sustained VT/VF in the acute phase of myocarditis compared to those implanted for VT/VF occurring on myocarditis sequelae. Our retrospective observational study included patients implanted with an ICD following VT/VF during acute myocarditis or VT/VF on myocarditis sequelae, from 2007 to 2017, in 15 French university hospitals. Over a median follow-up period of 3 years, MAE occurred in 11 (39%) patients of the acute myocarditis group and 24 (60%) patients of the myocarditis sequelae group. Kaplan–Meier MAE rate estimates at one and three years of follow-up were 19% and 45% in the acute group, and 43% and 64% in the sequelae group. Patients who experienced sustained ventricular arrhythmias during acute myocarditis had a very high risk of VT/VF recurrence during follow-up. These results show that the risk of MAE recurrence remains high after resolution of the acute episode.

Highlights

Myocarditis is an inflammatory disease of the myocardium that has a wide variety of clinical presentations and whose clinical course is poorly understood
The latest European and American recommendations clearly support the implantation of a cardiac defibrillator (ICD) as secondary prevention in patients who have had a major arrhythmic event (MAE) subsequent to myocarditis
We included a total of 68 patients treated in 15 French university hospitals over a 10 year period (2007–2017) in the primary analysis: 28 in the acute myocarditis group and 40 in the myocarditis sequelae group (Figure 1)

Summary

Introduction

Myocarditis is an inflammatory disease of the myocardium that has a wide variety of clinical presentations and whose clinical course is poorly understood. The latest European and American recommendations clearly support the implantation of a cardiac defibrillator (ICD) as secondary prevention in patients who have had a major arrhythmic event (MAE) subsequent to myocarditis. Implantation following severe ventricular arrhythmia in the acute phase of myocarditis is disputed, and according to some recommendations it should be limited to giant cell myocarditis and cardiac sarcoidosis [3,4]. Clinical approaches are varied: some centers implant patients during the acute phase of myocarditis, regardless of etiology, while other centers do not. While myocarditis has long been considered a reversible disease, advances in cardiac magnetic resonance imaging (MRI) have made it possible to show that myocardial damage persists long after the acute episode has been resolved. Grün et al found that, in about 50% of cases, scarring was still visible in the myocardium on MRI imaging (with late gadolinium enhancement (LGE)) 4 years after the initial event [5]

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