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High Risk of Sustained Ventricular Arrhythmia Recurrence After Acute Myocarditis.

ABSTRACT: Acute myocarditis is associated with cardiac arrhythmia in 25% of cases; a third of these arrhythmias are ventricular tachycardia (VT) or ventricular fibrillation (VF). The implantation of a cardiac defibrillator (ICD) following sustained ventricular arrhythmia remains controversial in these patients. We sought to assess the risk of major arrhythmic ventricular events (MAEs) over time in patients implanted with an ICD following sustained VT/VF in the acute phase of myocarditis compared to those implanted for VT/VF occurring on myocarditis sequelae. Our retrospective observational study included patients implanted with an ICD following VT/VF during acute myocarditis or VT/VF on myocarditis sequelae, from 2007 to 2017, in 15 French university hospitals. Over a median follow-up period of 3 years, MAE occurred in 11 (39%) patients of the acute myocarditis group and 24 (60%) patients of the myocarditis sequelae group. Kaplan-Meier MAE rate estimates at one and three years of follow-up were 19% and 45% in the acute group, and 43% and 64% in the sequelae group. Patients who experienced sustained ventricular arrhythmias during acute myocarditis had a very high risk of VT/VF recurrence during follow-up. These results show that the risk of MAE recurrence remains high after resolution of the acute episode.

SUBMITTER: Rosier L

PROVIDER: S-EPMC7141537 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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High Risk of Sustained Ventricular Arrhythmia Recurrence After Acute Myocarditis.

Rosier Laurent L Zouaghi Amir A Barré Valentin V Martins Raphaël R Probst Vincent V Marijon Eloi E Sadoul Nicolas N Chauveau Samuel S Da Costa Antoine A Badoz Marc M Peyrol Michael M Barraud Jérémie J Massoullie Grégoire G Eschalier Romain R Espinosa Madeline M Lesaffre François F Garcia Rodrigue R Degand Bruno B Noël Antoine A Mansourati Jacques J Extramiana Fabrice F Algalarrondo Vincent V Devilliers Hervé H Cottin Yves Y Gandjbakhch Estelle E Guenancia Charles C

Journal of clinical medicine 20200320 3

Acute myocarditis is associated with cardiac arrhythmia in 25% of cases; a third of these arrhythmias are ventricular tachycardia (VT) or ventricular fibrillation (VF). The implantation of a cardiac defibrillator (ICD) following sustained ventricular arrhythmia remains controversial in these patients. We sought to assess the risk of major arrhythmic ventricular events (MAEs) over time in patients implanted with an ICD following sustained VT/VF in the acute phase of myocarditis compared to those ...[more]

PMID: 32244983

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Project description:BackgroundRilonacept, a once-weekly interleukin-1 alpha and beta cytokine trap, reduced pericarditis recurrence in the phase 3 study, RHAPSODY (Rilonacept Inhibition of Interleukin-1 Alpha and Beta for Recurrent Pericarditis: A Pivotal Symptomatology and Outcomes Study). The RHAPSODY long-term extension further explored recurrent pericarditis natural history and treatment duration decision-making during 24 additional months of open-label rilonacept treatment.Methods and resultsSeventy-four patients commenced the long-term extension, with a median (maximum) total rilonacept duration of 22 (35) months. Individually, 18 months after the most proximal pericarditis recurrence, investigators decided to continue rilonacept on study, suspend rilonacept for off-treatment observation (rescue allowed), or discontinue the study. The annualized incidence of pericarditis recurrence on rilonacept up to the 18-month decision milestone was 0.04 events/patient-year versus 4.4 events/patient-year prestudy while on oral therapies. At the 18-month decision milestone, 64% (33/52) continued rilonacept, 15% (8/52) suspended rilonacept for observation, and 21% (11/52) discontinued the study. Among the 33 patients (1/33; 3.0%) continuing rilonacept (median time to recurrence could not be estimated due to too few events), a single recurrence occurred 4 weeks after a treatment interruption. Among patients suspending rilonacept, 75% (6/8) experienced recurrence (median time to recurrence, 11.8 weeks [95% CI, 3.7 weeks to not estimable]). There was a 98% reduction in risk of pericarditis recurrence among patients continuing rilonacept treatment after the 18-month decision milestone versus those suspending treatment for observation (hazard ratio, 0.02; P<0.0001).ConclusionsIn the RHAPSODY long-term extension, continued rilonacept treatment resulted in continued response; treatment suspension at the 18-month decision milestone was associated with pericarditis recurrence.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT03737110.

Dataset Information

High Risk of Sustained Ventricular Arrhythmia Recurrence After Acute Myocarditis.

Publications

High Risk of Sustained Ventricular Arrhythmia Recurrence After Acute Myocarditis.

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