Document Detail


Inflammatory left ventricular microaneurysms as a cause of apparently idiopathic ventricular tachyarrhythmias.
MedLine Citation:
PMID:  11447081     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: We sought to investigate the arrhythmogenic role, incidence, treatment, and prognosis of inflammatory left ventricular (LV) microaneurysms in patients with apparently idiopathic ventricular tachyarrhythmias. Methods and Results-- We studied 156 consecutive patients (71 men, 85 women; mean age, 44.1+/-11.8 years) with severe ventricular arrhythmias and normal 2D echo cardiac parameters by coronary and ventricular angiography, biventricular endomyocardial biopsy, and electrophysiological study. Polymerase chain reaction was used to detect genomic sequences of enterovirus, adenovirus, Epstein Barr virus, cytomegalovirus, herpes simplex viruses, influenza A and B viruses, and hepatitis C virus in frozen endomyocardial samples. Of these patients, 15 (9.6%) showed angiographic evidence of single or multiple LV microaneurysms. All 15 patients had recurrent episodes of ventricular tachycardia with right bundle-branch block morphology, and the arrhythmias originated within or close to the aneurysms in those patients (n=6) undergoing ventricular mapping. A lymphocytic myocarditis was observed in LV biopsies of all patients and in the right ventricles of 3 patients. Polymerase chain reaction analysis was performed in 12 and viral genomes were found in 5 (42%): hepatitis C virus in 2, enterovirus in 2, and influenza virus A in 1. The patients were treated with antiarrhythmics, and cardiac function was preserved for the next 47+/-39.5 months of follow-up. No major clinical event was registered, and arrhythmias were successfully treated by antiarrhythmics.
CONCLUSIONS: Inflammatory LV microaneurysms, often of viral origin, are a consistent cause of apparently idiopathic ventricular arrhythmias. Their prognosis so far has been benign, and aggressive therapeutic strategies have been unnecessary.
Authors:
C Chimenti; F Calabrese; G Thiene; M Pieroni; A Maseri; A Frustaci
Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Circulation     Volume:  104     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2001 Jul 
Date Detail:
Created Date:  2001-07-11     Completed Date:  2001-08-09     Revised Date:  2013-05-20    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  168-73     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, Catholic University, Rome, Italy.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Anti-Arrhythmia Agents / therapeutic use
Antibodies, Viral / blood
Biopsy
Bundle-Branch Block / complications,  diagnosis
Coronary Angiography
Echocardiography
Electrocardiography, Ambulatory
Electrophysiologic Techniques, Cardiac
Female
Heart Aneurysm / blood,  complications*,  diagnosis
Heart Ventricles / pathology,  virology
Humans
Male
Middle Aged
Myocarditis / blood,  complications*,  pathology
Polymerase Chain Reaction
Prognosis
RNA, Viral / isolation & purification
Tachycardia, Ventricular / diagnosis,  drug therapy,  etiology*
Virus Diseases / complications*,  diagnosis*
Chemical
Reg. No./Substance:
0/Anti-Arrhythmia Agents; 0/Antibodies, Viral; 0/RNA, Viral

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