[Interventional treatment in patients with myocarditis: Pro and Contra]

Area of Science:

• Cardiology
• Electrophysiology
• Inflammatory Heart Disease

Background:

• Ventricular tachyarrhythmias (VTs) are a significant concern in patients with inflammatory heart diseases.
• Myocarditis, an inflammatory heart condition, can lead to life-threatening VTs, necessitating tailored management strategies.
• VT management approaches may differ based on the specific type of myocarditis.

Purpose of the Study:

• To characterize VT patterns in patients with confirmed myocarditis.
• To assess the efficacy and safety of VT management strategies individualized to myocarditis type.
• To explore the relationship between myocarditis activity and VT recurrence.

Main Methods:

• Study included 56 patients with verified myocarditis and 18 controls with primary cardiomyopathy.
• All participants underwent clinical evaluation and endomyocardial biopsy with immunohistochemical analysis.
• Radiofrequency catheter ablation was performed in 40 patients, and implantable cardioverter-defibrillators (ICDs) were implanted in 17 patients.

Main Results:

• No significant demographic or echocardiographic differences were observed between myocarditis and control groups.
• In the myocarditis group, 59% experienced nonsustained VT/frequent premature ventricular beats, and 12.5% had sustained VT.
• VT ablation significantly reduced VT recurrence (p=0.0009); active myocarditis correlated with higher recurrence rates (67% vs. 19% in borderline).

Conclusions:

• Catheter ablation demonstrates partial efficacy in managing clinically significant VTs in selected myocarditis patients.
• Patients with borderline myocarditis and symptomatic VTs may benefit from ablation.
• Morphological diagnosis of myocarditis is crucial for guiding treatment decisions.