Assessment of patients presenting with life-threatening ventricular arrhythmias and suspected myocarditis: The key role of endomyocardial biopsy

Maria Lucia Narducci, Giulio La Rosa, Gaetano Pinnacchio, Frediano Inzani, Giulia D'Amati, Francesco Perna, Gianluigi Bencardino, Domenico D'Amario, Maurizio Pieroni, Antonio Dello Russo, Michela Casella, Gemma Pelargonio, Filippo Crea

Risultato della ricerca: Contributo in rivistaArticolo in rivista


Background: Life-threatening ventricular tachyarrhythmias (VAs) represent a significant cause of death in myocarditis. Objective: The purpose of this study was to identify predictors of sustained VAs in patients with myocarditis and ventricular phenotype diagnosed by workflow including endomyocardial biopsy (EMB) guided by 3D electroanatomic mapping (3D-EAM). Methods: We prospectively enrolled patients with suspected myocarditis and VAs, undergoing cardiac magnetic resonance, coronary angiography, 3D-EAM, and EMB guided by 3D-EAM. At follow-up, sustained VAs were detected by device interrogation and 24-hour electrocardiographic Holter monitoring. Results: We enrolled 54 consecutive patients (mean age 41 ± 14 years; 32 men) with normal ventricular function; left ventricular and right ventricular (RV) late gadolinium enhancement was present, respectively, in 21 (46%) and 6 (13%) of the 46 patients who underwent cardiac magnetic resonance. In 31 patients, the histological diagnosis was myocarditis, while in 14 patients, focal replacement myocardial fibrosis (FRMF); in 9 patients, specimens were inadequate (diagnostic yield of EMB 83%). 3D-EAM showed a larger endocardial scar area for both ventricles in myocarditis than in FRMF (RV bipolar mean scar area 22 ± 16 cm2 vs 3 ± 2 cm2; P = .02; left ventricular bipolar mean scar area 13 ± 5 cm2 vs 4 ± 2 cm2; P = .02, respectively). At a follow-up of 21 months, freedom from sustained VAs was 58% in myocarditis and 92% in FRMF (log-rank, P = .008). Histological diagnosis of myocarditis and RV endocardial scar were independent predictors of sustained VAs (P = .02 for both). Conclusion: Our data highlight the need for 3D-EAM-guided EMB in apparently healthy young patients with suspected myocarditis and VAs.
Lingua originaleEnglish
pagine (da-a)907-915
Numero di pagine9
RivistaHeart Rhythm
Stato di pubblicazionePubblicato - 2021


  • 3D electroanatomic mapping
  • Endomyocardial biopsy
  • Innovative biotechnology
  • Myocarditis
  • Personalized medicine
  • Ventricular arrhythmias


Entra nei temi di ricerca di 'Assessment of patients presenting with life-threatening ventricular arrhythmias and suspected myocarditis: The key role of endomyocardial biopsy'. Insieme formano una fingerprint unica.

Cita questo