RT-124
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Severe ventricular arrhythmias caused by occult inflammatory left ventricular aneurysms
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Cristina Chimenti, Maurizio Pieroni, Fulvio Bellocci, Andrea Frustaci.
Cardiology Institute, Catholic University, Rome, Italy
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Abstract
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BACKGROUND. Severe ventricular arrhythmias
may occur in patients with left ventricular aneurysms of different origin. Nevertheless
the cause of tachyarrhythmias in patients with normal cardiac function and without
coronary artery disease remains often unclear.
METHODS. Among 370 pts with a histologic diagnosis of myocarditis, 10 (2.7%, mean
age 38.5±19 years) patiens presenting with sustained or non sustained ventricular
tachycardia had single or multiple left ventricular aneurysms (length=10.6±3.1 mm;
width=7.4±4.2 mm) with normal cardiac function. All patients underwent laboratory
tests, non invasive and invasive cardiac exams including biventricular endomyocardial
biopsy.
RESULTS. Left ventricular aneurysms were no evident at two-dimensional
echocardiography and were revealed unpredictably at left ventricular angiography.
In all pts left ventricular endomyo-cardial biopsy showed a lymphocytic myocarditis
with focal myo-cytolysis while right ventricular biopsy was diagnostic for myo-carditis
only in 3 cases. Serology suggested a viral infection in 2 patients, an immunologic
disorder in 1. In 4 patients with sustained ventricular tachycardia the electrophysiologic
study with biventricular mapping showed the arrhythmia originating within or near the
aneurysms. Treatment included antiarrhythmics associated with immunosuppression
(prednisone and azathioprine for 5 months) in 2 patients with active myocarditis.
CONCLUSION. In conclusion severe ventricular arrhythmias appearing in young
patients with apparently normal heart may be caused by localized inflammatory left
ventricular aneurysms.
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Key Words
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