Giant Cell Myocarditis with Incessant Ventricular Arrhythmias Treated Successfully with Methylprednisolone and Rat Antithymocyte Globulin

Baig, Mudassar; Hatrick, Rob

doi:10.4061/2011/925104

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…Some case reports have suggested that immunosuppression may suppress arrhythmias, too, 17,19 but other reports show failures. 15,20 In our study, the response of VTs to standard amiodarone therapy was inconsistent, although the frequency of recurrences was reduced in most patients.…”

Section: Discussionmentioning

confidence: 99%

“…A more recent multicenter study of 1-year GCM survivors found that 6 of 26 patients experienced recurrent VTs during a mean follow-up of 5.5 years, but no new VTs were observed in patients free of arrhythmias at presentation. 8 Although the above studies and several case reports [15][16][17][18][19][20] have suggested that ventricular tachyarrhythmias are both common and important in GCM, no in-depth research focusing on this subject has been published from outside our institution.…”

Section: Discussionmentioning

confidence: 99%

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Incidence, Risk Factors, and Outcome of Life-Threatening Ventricular Arrhythmias in Giant Cell Myocarditis

Ekström

Lehtonen

Kandolin

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background-Ventricular tachyarrhythmias are characteristic of giant cell myocarditis, but their true incidence, predictors, and outcome are unknown. Methods and Results-Our work involved 51 patients with giant cell myocarditis (35 women) aged 52±12 years. Their medical records were reviewed for history, results of laboratory and imaging studies, and occurrence of serious cardiac events, including life-threatening ventricular tachyarrhythmias. Sudden cardiac death (fatal or aborted) was the primary end point of our analyses, whereas the composite of sudden cardiac death and ventricular tachycardia requiring treatment constituted the secondary end point. Giant cell myocarditis presented as nonfatal ventricular tachyarrhythmia in 10 patients and as a fatal cardiac arrest in 1 patient. Overall, 14 of 50 patients suffered a sudden cardiac death during followup, with a cumulative incidence of 22% at 1 year and 26% at 5 years from presentation. The composite incidence of sudden cardiac death or ventricular tachycardia was 41% at 1 year and 55% at 5 years. The incidence of arrhythmias was associated with high plasma concentrations of troponin-T and N-terminal brain natriuretic propeptide, as well as with moderate-to-severe fibrosis on myocardial biopsy and history of ventricular tachyarrhythmias at presentation (P<0.05 for all). An intracardiac cardioverter defibrillator was implanted in 31 patients, of whom 17 had altogether 114 appropriate antiarrhythmic therapies by the device and none suffered an arrhythmic death. Conclusions-In giant cell myocarditis, the risk of life-threatening ventricular arrhythmias exceeds 50% at 5 years from admission, being related to the presenting clinical manifestation and markers of myocardial injury and scarring.(Circ Arrhythm Electrophysiol. 2016;9:e004559.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Incidence, Risk Factors, and Outcome of Life-Threatening Ventricular Arrhythmias in Giant Cell Myocarditis

Ekström

Lehtonen

Kandolin

et al. 2016

Circ: Arrhythmia and Electrophysiology

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“…18 There are further anecdotal data from case reports of clinical improvement after immunosuppression with combinations of steroid, cyclosporine, azathioprine, muromonab-CD3, and rabbit antithymocyte globulin. 19 Heart transplantation is an effective therapy, with a 71% 5-year survival; however, GCM recurs in ≈20% to 25% of patients. 12 The decision to use an ICD and the timing of ICD placement in such cases are challenging.…”

Section: Invasive Cardiac Electrophysiology Testing Was Normal With mentioning

confidence: 99%

Chest Pain and Palpitations

2013

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A 25-year-old man of Pakistani origin born in the United Kingdom was admitted with a 3-day history of chest tightness and palpitations. The chest tightness was central and heavy in nature with no radiation. Palpitations were regular, and both symptoms occurred in paroxysms of up to 10 seconds. He had never experienced these symptoms before. He had a medical history of well-controlled asthma on β-adrenergic agonist and steroid inhalers, and he was morbidly obese with a body mass index of 43 kg/m 2 . He smoked 2 cigarettes per day and denied consuming alcohol or illicit drugs. He lived with his parents and worked as the manager of an online retail company. His mother had suffered a previous transient ischemic attack; his father had a myocardial infarction in his 40s and was treated for pulmonary tuberculosis in 1985.Dr Lefroy: This young patient presents with recent chest pain and palpitations. The differential diagnosis is wide at this stage; in an older patient, it would be most important to consider and exclude acute coronary syndrome. Although uncommon in younger patients, an acute coronary syndrome can occur in those with traditional risk factors such as smoking, obesity, hypertension, and diabetes mellitus. A number of inherited disorders also predispose to premature coronary artery disease such as familial hypercholesterolemia and factor V Leiden. Other rare causes include spontaneous coronary artery dissection and paradoxical embolism through a patent foramen ovale. It is also important to consider vasospasm from illicit drugs such as cocaine.Myocarditis should also be considered as a differential for this patient. Such patients may present with heart failure, cardiac arrhythmias, or chest pain mimicking acute coronary syndrome. It is also possible that cardiac arrhythmia is the primary pathology with the symptom of chest tightness secondary to tachycardia.Finally, it is important to consider gastric pathology such as gastroesophageal reflux or esophageal spasm in the differential diagnosis. Young patients may also suffer from anxiety-related chest symptoms and palpitations with no organic pathology, but this should be a diagnosis of exclusion.On examination, heart sounds 1 and 2 were present with no added sounds. The apex beat was not displaced and jugular venous pressure was not elevated. The chest was clear to auscultation. His abdomen was soft and not tender with no organomegaly. His blood pressure was 113/72 mm Hg , pulse was 93 bpm, oxygen saturation was 96% on air, and temperature was 36.5°C. His admission ECG is shown in Figure 1.Dr Lefroy: His ECG is abnormal and demonstrates sinus rhythm, occasional premature atrial contraction/premature ventricular contraction, and ST-segment elevation with biphasic T wave in leads V2 and V3. This pattern has been called a Wellen pattern that associated with proximal left anterior descending artery stenosis. Multifocal ventricular ectopics are a worrying feature in the presentation, indicating ventricular hyperexcitability secondary to either myocardial ischemia...

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An alternative immunosuppressive regimen to prolong transplant free survival in a patient with giant cell myocarditis

Grabmaier

Brenner

Methe

et al. 2013

International Journal of Cardiology

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Giant Cell Myocarditis with Incessant Ventricular Arrhythmias Treated Successfully with Methylprednisolone and Rat Antithymocyte Globulin

Cited by 3 publications

References 9 publications

Incidence, Risk Factors, and Outcome of Life-Threatening Ventricular Arrhythmias in Giant Cell Myocarditis

Incidence, Risk Factors, and Outcome of Life-Threatening Ventricular Arrhythmias in Giant Cell Myocarditis

Chest Pain and Palpitations

An alternative immunosuppressive regimen to prolong transplant free survival in a patient with giant cell myocarditis

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