M MYOCARDITIS X PVC

Myocarditis Causing Premature Ventricular Contractions

Circulation: Arrhythmia and Electrophysiology

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• The purpose of the study was to discern if underlying inflammation is present in patients with frequent premature ventricular contractions (PVCs). The authors prospectively assessed 107 patients with frequent symptomatic PVCs (>5000/24 hr) and no known ischemic heart disease. Testing included lab studies, 18F-FDG PET, cardiac MRI, and biopsy. A multidisciplinary team established diagnoses of myocarditis and recommended immunosuppressive therapy. Positive PET findings were seen in 55 patients. Of these patients, 32 were treated with immunosuppressive therapy alone; 14 were treated with both immunosuppressive therapy and catheter ablation. Optimal response occurred in 31 (67%) of 46 treated patients over a mean 6-month follow-up period.

• Approximately 51% of patients in this cohort with frequent PVCs had underlying myocardial inflammation. Use of 18F-FDG PET can aid in early diagnosis. In appropriately selected patients, treatment with immunosuppressive therapy can improve clinical outcomes.

Abstract

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BACKGROUND

Premature ventricular contractions are a common clinical presentation that drives further diagnostic workup. We hypothesize the presence of underlying inflammation is often unrecognized in these patients with a potential for continued disease progression if not diagnosed and treated early in the disease course.

METHODS

This is a single-center, prospective study including 107 patients with frequent symptomatic premature ventricular contractions (>5000/24 h) and no known ischemic heart disease. Patients underwent a combination of laboratory testing, 18F-fluorodeoxyglucose positron emission tomography scan, cardiac magnetic resonance imaging, and biopsy. Patients were diagnosed with myocarditis based on a multidisciplinary approach and treated with immunosuppressive therapy.

RESULTS

The mean age of the cohort was 57±15 years, 41% were males, and left ventricular ejection fraction was 47±11.8%. Positive positron emission tomography scan was seen in 51% (55/107), of which 51% (28/55) had preserved left ventricle function. Based on clinical profile, 18F-fluorodeoxyglucose-positron emission tomography imaging, cardiac magnetic resonance, and histological data 58% patients (32/55) received immunosuppressive therapy alone and 25.4% (14/55) received immunosuppressive therapy and catheter ablation. Optimal response was seen in 67% (31/46) over a mean follow-up of 6±3 months. In patients with left ventricle systolic dysfunction, 37% (10/27) showed an improvement in mean left ventricular ejection fraction of 13±6%.

CONCLUSIONS

Approximately 51% of patients presenting with frequent premature ventricular contractions have underlying myocardial inflammation in this cohort. 18F-fluorodeoxyglucose-positron emission tomography scan can be a useful modality for early diagnosis and treatment with immunosuppressive therapy in selected patients can improve clinical outcomes.