Monomorphic Ventricular Tachycardia and Mediastinal Adenopathy Due to Granulomatous Infiltration in Patients With Preserved Ventricular Function

Thachil, Ajit; Christopher, Johann; Sastry, B.K.S.; Reddy, Kavitha Nallapa; Tourani, Vijaya; Hassan, Ashfaq Ul; Raju, Bhupathiraju Soma; Narasimhan, Calambur

doi:10.1016/j.jacc.2011.02.044

Cited by 34 publications

(40 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A recent study with FDG-PET in patients with sustained monomorphic ventricular tachycardia and sarcoidosis or tuberculosis demonstrated that myocardial inflammation may cause life-threatening ventricular arrhythmias and abnormal electroanatomic mapping findings even in the absence of scar at cardiac magnetic resonance and in the presence of normal ventricular dimensions and function. 26 Moreover, it has been demonstrated that continuing myocardial damage can persist even in the absence of overt inflammation, for example, through the release of viral proteases capable of cleaving cytoskeletal dystrophin. 27,28 The 2006 European Society of Cardiology/American College of Cardiology/American Heart Association guidelines on ventricular arrhythmias and sudden cardiac death 10 recommend drug therapy for life-threatening ventricular arrhythmias in myocarditis.…”

Section: Ventricular Arrhythmias In Myocarditismentioning

confidence: 99%

Drug-Refractory Ventricular Tachycardias After Myocarditis

Russo

Casella

Pieroni

et al. 2012

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

Background-Ventricular tachycardia (VT) is a significant therapeutic challenge in patients with myocarditis. This study aimed to assess the efficacy and safety of radiofrequency catheter ablation (RFCA) of VT in patients with myocarditis. Methods and Results-We enrolled 20 patients (15 men; age, 42 [28-52] years) with a history of biopsy-proven viral myocarditis and drug-refractory VT; 5 patients presented with electrical storm. The median left ventricular ejection fraction was 55% (45-60%). All patients underwent endocardial RFCA with an irrigated catheter, using contact electroanatomic mapping. Recurrence of sustained VT after endocardial RFCA was treated with additional epicardial RFCA. Endocardial RFCA was acutely successful in 14 patients (70%) while in the remaining 6 (30%) clinical VT was successfully ablated by epicardial RFCA. In 1 patient, hemodynamic instability required an intra-aortic balloon pump to complete RFCA. No major complication occurred during or after RFCA. Over a median follow-up time of 28 (11-48) months, 18 patients (90%) remained free of sustained VT; 2 patients (10%, both with baseline left ventricular ejection fraction ≤35%) died of acute heart failure unrelated to ventricular arrhythmias. Conclusions-In patients with myocarditis, RFCA of drug-refractory VT is feasible, safe, and effective. Epicardial RFCA should be considered as an important therapeutic option to increase success rate. (Circ Arrhythm Electrophysiol. 2012;5:492-498.)

show abstract

Section: Ventricular Arrhythmias In Myocarditismentioning

confidence: 99%

Drug-Refractory Ventricular Tachycardias After Myocarditis

Russo

Casella

Pieroni

et al. 2012

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

show abstract

“…Recurrence was significantly reduced from “6.5 VTs/patient-year to 0.6 VTs/patient-year” by introducing disease-specific therapy [6]. In both our patients, treatment consisted of antiarrhythmic drugs, quadruple anti-tuberculous medication and the implantation of an ICD, with successful outcome.…”

Section: Discussionmentioning

confidence: 78%

“…Significant lymphadenopathy became apparent, raising the possibility of TB or sarcoidosis. In select cases endomyocardial biopsies were performed to seek a histopathological diagnosis and tissue for TB culture [6]. The importance of searching for lymphadenopathy is highlighted in this study whereby even in those patients without cardiac inflammation on CMR, mediastinal nodes were found on PET.…”

Section: Discussionmentioning

confidence: 95%

See 1 more Smart Citation

Two cases of culture proven Mycobacterium tuberculosis presenting with a broad-complex tachycardia and non-caseating granulomas

Farah

Beasley

Berry

et al. 2014

Respiratory Medicine Case Reports

View full text Add to dashboard Cite

Tuberculosis is a leading cause of death worldwide. It affects pulmonary and extra-pulmonary sites with a multitude of differing presentations. In this report, we describe two cases in which TB causes myopericarditis and presents with a broad-complex tachycardia that did not respond typically to standard anti-arrhythmic therapy; a very rare presentation with limited description in the literature. Both patients required extensive investigation culminating in identifying lymph nodes amenable to biopsy under endobronchial ultrasound guidance. It was not until both patients received anti-tuberculous chemotherapy alongside anti-arrhythmic management that any improvement to their condition was witnessed. Therefore, we recommend that the clinician should have a high index of suspicion for TB in any patient presenting with a broad-complex tachycardia that is not responding to standard first line management, especially if the patient is from a high risk background. We recommend an active diagnostic pursuit, and lymph node biopsy under endobronchial ultrasound guidance.

show abstract

“…Granulomatous myocardial infiltration or fibrosis enhances abnormal automaticity and re-entrant substrate [107]. These arrhythmias can be observed during CS without cardiac dysfunction [108]. Ventricular ectopic beats are frequent (37% of cases).…”

Section: Electrocardiogrammentioning

confidence: 99%

Cardiac sarcoidosis

Chapelon-Abric

2012

La Presse Médicale

View full text Add to dashboard Cite

Monomorphic Ventricular Tachycardia and Mediastinal Adenopathy Due to Granulomatous Infiltration in Patients With Preserved Ventricular Function

Cited by 34 publications

References 9 publications

Drug-Refractory Ventricular Tachycardias After Myocarditis

Drug-Refractory Ventricular Tachycardias After Myocarditis

Two cases of culture proven Mycobacterium tuberculosis presenting with a broad-complex tachycardia and non-caseating granulomas

Cardiac sarcoidosis

Contact Info

Product

Resources

About