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What Is the Arrhythmic Substrate in Viral Myocarditis? Insights from Clinical and Animal Studies

Gary Tse1, Jie M Yeo2, Yin Wah Chan3

  • 1Li Ka Shing Faculty of Medicine, School of Biomedical Sciences, University of Hong KongHong Kong, China; Department of Medicine and Therapeutics, The Chinese University of Hong KongHong Kong, China.

Frontiers in Physiology
|August 6, 2016
PubMed

Insights

Sudden cardiac death (SCD) is often caused by ventricular arrhythmias. Viral myocarditis is a significant, increasingly recognized cause of SCD, particularly in young individuals, due to inflammation and ion channel dysfunction.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Virology

Background:

  • Sudden cardiac death (SCD) is a major unsolved clinical problem, frequently caused by ventricular arrhythmias.
  • Viral myocarditis is an emerging cause of unexplained mortality and SCD, especially in younger populations.
  • Myocardial inflammation and cellular remodeling are implicated in arrhythmogenesis.

Purpose of the Study:

  • To review the electrophysiology of action potential conduction and repolarization in the context of viral myocarditis.
  • To elucidate mechanisms of triggered and reentrant arrhythmogenesis in viral myocarditis.
  • To discuss current and future management strategies for viral myocarditis.

Main Methods:

  • Synthesis of experimental evidence from pre-clinical and clinical studies.
  • Examination of host (inflammation) and viral (altered cellular signaling) factors.
  • Illustration of ion electrophysiological and structural remodeling pathways.

Main Results:

  • Viral myocarditis induces significant electrophysiological and structural remodeling of the myocardium.
  • Inflammation and altered cellular signaling contribute to ion channel dysfunction and arrhythmias.
  • Current treatments are largely supportive, with heart transplantation as a last resort.

Conclusions:

  • Viral myocarditis is a critical, under-recognized cause of life-threatening arrhythmias and SCD.
  • Understanding the electrophysiological mechanisms is key to developing targeted therapies.
  • Future strategies should focus on mitigating inflammation and remodeling in viral myocarditis.

Keywords:
cardiac arrhythmiaconductionmouse modelrepolarizationviral myocarditisviral-induced cardiomyopathy

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