Saturday, August 13, 2016

Myocardial Biopsy In “Idiopathic» Atrial Fibrillation And Other Arrhythmias: Nosological Diagnosis, Clinical And Morphological Parallels, And Treatment

O.V.Blagova, A.V.Nedostup, E.A.Kogan, V.A.Sulimov, S.A.Abugov, A.G.Kupryanova,V.A.Zaydenov, 
A.E.Donnikov, E.V.Zaklyazminskaya, E.A.Okisheva

Background: The nosological nature of “idiopathic” arrhythmias and the effect of etiotropic and pathogenetic treatment are often unknown.
Methods And Results: 19 patients (42.6±11.3 years, 9 women) with atrial fibrillation (n = 16), supraventricular (n = 10) and ventricular (n = 4) premature beats, supraventricular (n = 2) and ventricular tachycardia (n = 1), left bundle branch block (n= 2), AV block (n = 2) without structural heart changes. Viruses were identified (polymerase chain reaction, PCR) along with measurement of anti-heart antibodies (AHA) and endomyocardial biopsy (EMB).
EMB allowed to establish diagnosis in all patients: 1) infectious-immune myocarditis (n = 11, parvovirus-positive in 1), 2) parvovirus-positive endomyocarditis (n = 1), 3) systemic (n = 2) and myocardial (n = 1) vasculitis, 4) Fabry’s disease (n = 1), 5) arrhythmogenic right ventricular dysplasia (n = 1), 6) unspecified genetic cardiomyopathy (n = 2, herpes virus 6 one positive). Level of AHA had the greatest significance for myocarditis diagnostics. All patients with myocarditis/vasculitis had background therapy: acyclovir (n = 10), IV immunoglobulin (n = 2), meloxicam (n = 12), hydroxychloroquine (n = 15), steroids (n = 14, 31.1±12.5 mg/day), azathioprine 150 mg/day (n = 2). Median follow-up was 4 years. Treatment significantly reduced the rate of arrhythmias (8 [5;8] to 3 [1.25;7.75] points); disappearance of bundle branch block was noted.
Conclusion: EMB allowed to diagnose immune-mediated inflammatory diseases in 78.9% patients with ‘idiopathic’ arrhythmias and genetic diseases in 21.1%. Background therapy of myocarditis improved the antiarrhythmic efficiency, and allowed the best premed for interventional treatment.

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