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


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 (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.

Credits: 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



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