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Autoimmune Myocarditis and Arrhythmogenic Mitral Valve Prolapse: An Unexpected Overlap Syndrome.


ABSTRACT:

Background

both myocarditis and mitral valve prolapse (MVP) are known uncommon causes of ventricular arrhythmias in young patients.

Aim

to report the first clinical case of endomyocardial biopsy (EMB)-proven autoimmune myocarditis and associated arrhythmogenic MVP in a patient with recurrent ventricular fibrillation (VF) episodes.

Methods

myocarditis was diagnosed both by cardiac magnetic resonance (CMR) and EMB. Arrhythmogenic MVP was documented by transthoracic echocardiogram, CMR, and electroanatomical mapping of the trigger premature ventricular contractions (PVCs).

Results

a 22-year-old woman underwent immunosuppressive therapy after EMB-proven diagnosis of autoimmune myocarditis with VF onset and early implantable cardioverter defibrillator (ICD) placement. Three years later, she experienced two VF recurrences and persistent PVCs, despite no signs of myocarditis recurrence. An echocardiogram revealed bileaflet MVP with high arrhythmic risk features. Finally, electroanatomical mapping and ablation of the trigger PVC were successfully performed.

Conclusion

in patients with recurrent VF episodes despite evidence-based medical treatment for myocarditis, MVP should be considered as an alternative arrhythmogenic substrate, and warrants early ICD implant and PVC-targeted therapy.

SUBMITTER: Villatore A 

PROVIDER: S-EPMC8619916 | biostudies-literature | 2021 Nov

REPOSITORIES: biostudies-literature

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Autoimmune Myocarditis and Arrhythmogenic Mitral Valve Prolapse: An Unexpected Overlap Syndrome.

Villatore Andrea A   Sala Simone S   Stella Stefano S   Vignale Davide D   Busnardo Elena E   Esposito Antonio A   Basso Cristina C   Della Bella Paolo P   Mazzone Patrizio P   Peretto Giovanni G  

Journal of cardiovascular development and disease 20211106 11


<h4>Background</h4>both myocarditis and mitral valve prolapse (MVP) are known uncommon causes of ventricular arrhythmias in young patients.<h4>Aim</h4>to report the first clinical case of endomyocardial biopsy (EMB)-proven autoimmune myocarditis and associated arrhythmogenic MVP in a patient with recurrent ventricular fibrillation (VF) episodes.<h4>Methods</h4>myocarditis was diagnosed both by cardiac magnetic resonance (CMR) and EMB. Arrhythmogenic MVP was documented by transthoracic echocardio  ...[more]

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