Arrhythmias Associated with Inflammatory Cardiomyopathies
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(2020) 22:76
Arrhythmia (R Kabra, Section Editor)
Arrhythmias Associated with Inflammatory Cardiomyopathies Roshan Karki, MBBS Chaitra Janga, MBBS Abhishek J. Deshmukh, MBBS* Address * Division of Cardiovascular Disease, Mayo Clinic, 200 1st Street, Rochester, MN, 55905, USA Email: [email protected]
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Arrhythmia Keywords Inflammatory cardiomyopathy I Arrhythmias I Cardiac sarcoidosis Abbreviations AIC Arrhythmogenic inflammatory cardiomyopathy carditis
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CS Cardiac sarcoidosis
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GCM Giant-cell myo-
Abstract Purpose of review To provide an approach to the diagnosis and treatment of arrhythmias associated with inflammatory cardiomyopathies. Recent findings Inflammatory cardiomyopathies are increasingly recognized as the etiology of both ventricular and supraventricular arrhythmias. There have been recent studies providing novel insights into the pathogenesis of arrhythmias in inflammatory cardiomyopathies and exploring the role of various diagnostic tools and treatment strategies. Summary Patients with inflammatory cardiomyopathies often present with one or more arrhythmias, including atrioventricular block, atrial and ventricular tachyarrhythmias, and occasionally sudden cardiac death. Given dynamic pathophysiology and heterogeneous presentation, the management of arrhythmias in these patients presents unique challenges. We review the current approach to the diagnosis and treatment of arrhythmias in this challenging cohort of patients with an emphasis on cardiac sarcoidosis.
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Curr Treat Options Cardio Med
(2020) 22:76
Introduction Inflammatory cardiomyopathies (ICMs) are a spectrum of disorders characterized by acute or chronic inflammatory processes affecting the myocardium (myocarditis) and associated with mechanical cardiac dysfunction with altered hemodynamics, conduction disturbances, or electrical instability. Inflammatory cardiomyopathies are mostly caused by an infection or autoimmune disease that has been summarized in Table 1. The patients with ICMs frequently present with arrhythmias.
However, a subset of these patients may present first with arrhythmias and even sudden cardiac death, and are later diagnosed as ICMs [1]. Bauer and colleagues [2••] proposed an operational diagnosis of “arrhythmogenic inflammatory cardiomyopathy” for these patients until a specific etiologic diagnosis is made. In the current review, we discuss an approach to the diagnosis and treatment of arrhythmias associated with ICMs with an emphasis on cardiac sarcoidosis (CS).
Epidemiology Although the global annual incidence of reported myocarditis is 22 per 100,000 [3], the actual burden of arrhythmias associated with ICM is unknown. In an autopsy study (n = 753, age G 50 years) of sudden cardiac deaths (SCDs), the prevalence of myocarditis was 6% [4]. Tung et al. demonstrated a 49% prevalence of occult myocardial inflammation by fluorodeoxyglucose positron emission tomography
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