Author + information
- Received January 9, 1984
- Revision received April 24, 1984
- Accepted May 11, 1984
- Published online October 1, 1984.
- Paul A. Vignola, MD, FACC*,1,
- Kazutaka Aonuma, MD1,
- Paul S. Swaye, MD, FACC1,
- John J. Rozanski, MD, FACC1,
- Ronald L. Blankstein, MD, FACC1,
- Jerome Benson, MD1,
- Arthur J. Gosselin, MD, FACC1 and
- John W. Lister, MD, FACC1
- ↵*Address for reprints: Paul A. Vignola, MD, Cardiovascular Laboratory, Miami Heart Institute, 4701 North Meridian Avenue, Miami Beach, Florida 33140.
During a period of 18 months beginning in January 1982, a total of 65 patients were referred to the Miami Heart Institute for evaluation of either aborted out of hospital sudden death, ventricular tachycardia resistant to standard clinically directed antiarrhythmic medication programs or high grade ventricular arrhythmia (Lown class ≥ IV B) with or without syncope. After complete evaluation including cardiac catheterization in all but 1 patient, 17 patients were identified in whom no obvious cardiac disease could be found. Twelve of the 17 underwent right ventricular endomyocardial biopsy. Six of the 12 biopsies demonstrated clinically unsuspected lymphocytic myocarditis (Group A). Findings in three of the remaining six biopsies were consistent with an early cardiomyopathy and in three were completely normal (Group B). Retrospective review of the clinical, laboratory, electrophysiologic, hemodynamic and angiographic data failed to identify a marker that reliably separated Group A from Group B patients.
In addition to antiarrhythmic therapy guided by laboratory electrophysiologic study, all Group A patients were treated with prednisone and azathioprine. After 6 months of immunosuppression, all patients with myocarditis were reevaluated in the hospital without antiarrhythmic medication. Ventricular tachycardia/fibrillation could not be provoked in the laboratory during repeat electrophysiologic testing in five of the six patients. Repeat myocardial biopsy after all immunosuppressive therapy had been discontinued revealed absence of inflammation associated with varying degrees of residual interstitial fibrosis. There were no deaths.
It was concluded that a patient with an otherwise clinically silent lymphocytic myocarditis can present with potentially life-threatening ventricular arrhythmias. The diagnosis can only be made with certainty by endomyocardial biopsy. Our preliminary uncontrolled observations suggest that such patients may have a beneficial electrophysiologic and histologic response to a course of immunosuppressive therapy.
- Received January 9, 1984.
- Revision received April 24, 1984.
- Accepted May 11, 1984.
- American College of Cardiology Foundation