Myocarditis Causing Premature Ventricular Contractions: Insights From the MAVERIC Registry

Dhanunjaya Lakkireddy, Mohit K. Turagam, Bharath Yarlagadda, Tawseef Dar, Mark Hamblin, Megan Krause, Valay Parikh, Sudharani Bommana, Donita Atkins, Luigi Di Biase, Sanghamitra Mohanty, Thomas Rosamond, Heidi Carroll, Cheri Nydegger, Louis Wetzel, Rakesh Gopinathannair, Andrea Natale

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Article numbere007520
JournalCirculation: Arrhythmia and Electrophysiology
Volume12
Issue number12
DOIs
StatePublished - Dec 1 2019

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Keywords

  • catheter ablation
  • disease progression
  • early diagnosis
  • myocarditis
  • positron emission tomography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Lakkireddy, D., Turagam, M. K., Yarlagadda, B., Dar, T., Hamblin, M., Krause, M., Parikh, V., Bommana, S., Atkins, D., Di Biase, L., Mohanty, S., Rosamond, T., Carroll, H., Nydegger, C., Wetzel, L., Gopinathannair, R., & Natale, A. (2019). Myocarditis Causing Premature Ventricular Contractions: Insights From the MAVERIC Registry. Circulation: Arrhythmia and Electrophysiology, 12(12), [e007520]. https://doi.org/10.1161/CIRCEP.119.007520