Log in to MyACC
Tachycardia After Ablation in Patients With Myocarditis
Quick Takes
- Among patients with myocarditis, active myocardial inflammation, as demonstrated by endomyocardial biopsy or advanced imaging, is a powerful predictor of recurrent ventricular tachycardia (VT) following catheter ablation.
- VT ablation should be avoided during acute myocarditis, but may be of benefit for patients with recurrent VT after acute inflammation subsides.
Study Questions:
What are the results of ventricular tachycardia (VT) ablation in patients with myocarditis, and what are the predictors of VT recurrence?
Methods:
Consecutive patients with myocarditis, undergoing VT ablation, were enrolled. The primary study endpoint was assessment of VT recurrences by 12-month follow-up. Predictors of VT recurrences were retrospectively identified.
Results:
A total of 125 patients (average left ventricular ejection fraction 52%) had multiple episodes of drug-refractory VTs. Multimodal preprocedural staging identified 47 patients with active myocarditis (AM: 38%) and 78 patients with previous myocarditis (PM: 62%). All patients showed low-voltage areas on electroanatomical maps. VT recurrences were documented in 25 patients (20%) by 12 months, and in 43 (34%) by last follow-up. At multivariable analysis, AM stage was the only predictor of VT recurrences by 12 months (p < 0.001). No VT episodes were found after redo ablation was performed in 23 patients during PM stage.
Conclusions:
The authors concluded that VT ablation should be avoided during acute myocarditis, but may be of benefit for recurrent VT after acute inflammation subsides.
Perspective:
In general, myocarditis is an underdiagnosed condition, especially when associated with ventricular arrhythmia. Ventricular arrhythmias may be secondary to lymphocytic myocarditis, although they are more commonly associated with giant cell or cardiac sarcoidosis. The present study shows that VT recurrences were frequent following ablation during the acute phase of inflammation. Further studies are needed to optimally assess inflammatory activity as a guide for the timing of catheter-based ablation procedures.
Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure
Keywords: Arrhythmias, Cardiac, Biopsy, Cardiomyopathies, Catheter Ablation, Diagnostic Imaging, Heart Failure, Inflammation, Myocarditis, Recurrence, Sarcoidosis, Stroke Volume, Tachycardia, Ventricular, Ventricular Function, Left
< Back to Listings
