Continuous Electrical Monitoring in Patients with Arrhythmic Myocarditis: Insights from a Referral Center
Giovanni Peretto1,2,3, Patrizio Mazzone1, Gabriele Paglino1
1Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
Insights
Continuous arrhythmia monitoring (CAM) accurately detects arrhythmias in patients with myocarditis, improving diagnosis and clinical management. This method is superior to Holter ECG for identifying ventricular arrhythmias.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Diagnostics
Background:
- Arrhythmias in myocarditis are frequently under-diagnosed and under-reported.
- Myocarditis poses a significant burden due to associated cardiac arrhythmias.
Purpose of the Study:
- To evaluate the diagnostic yield of continuous arrhythmia monitoring (CAM).
- To assess the clinical impact of CAM in patients diagnosed with arrhythmic myocarditis.
Main Methods:
- 104 adult patients with biopsy-proven active myocarditis and new ventricular arrhythmias (VAs) were enrolled.
- Patients underwent sequential 24-hour Holter ECGs and CAM (ICD or loop recorder).
Main Results:
- CAM identified significantly more patients with VAs (VT, NSVT, PVCs) compared to Holter ECG.
- CAM detected more VA episodes and earlier onset of NSVT.
- An ICD implantation strategy was beneficial for 80% of patients; histological findings predicted VT occurrence.
Conclusions:
- Continuous arrhythmia monitoring (CAM) enables accurate detection of arrhythmias in patients with myocarditis.
- CAM demonstrates a substantial clinical impact on patient management and outcomes.
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.
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