Immunosuppressive treatment for myocarditis and borderline myocarditis in children with ventricular ectopic rhytm

Seshadri Balaji, Henry B. Wiles, Mary Ann Sens, Paul C. Gillette

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Objectives-To ascertain the responsiveness to immunosuppressive treatment of myocarditis and borderline myocarditis in children with ventricular ectopic rhythm (that is, all ventricular arrhythmia except benign premature ventricular contractions). To determine the impact of the diagnostic information provided by an endomyocardial biopsy specimen in these patients. Background-The therapeutic value of performing an endomyocardial biopsy in children with ventricular ectopic rhythm is not established. In turn, the treatment of myocarditis with immunosuppressive drugs is also controversial. Methods-The case notes and endomyocardial biopsy findings of all children with ventricular ectopic rhythm and a biopsy diagnosis of myocarditis were reviewed. Results-Ten (14%) of 69 patients with ventricular ectopic rhythm and an anatomically normal heart had histological evidence of myocarditis or borderline myocarditis. Eight patients received corticosteroids and efficacy was judged by regular 24 hour Holter monitoring. Total resolution of arrhythmia was seen in four, improvement in two, and no change in two patients. At follow up (8-39 months, mean 22 months), arrhythmia recurrence was seen in the two patients who showed an improvement but not resolution during treatment. Both received azathioprine with fiurther reduction in ectopy rates. Patients who responded to treatment were symptomatic (six of six patients) at presentation compared with those who did not respond to treatment (none of two patients) who were not symptomatic. Five patients had a repeat biopsy specimen taken which confirmed histological impnrovemtent. Conclusions-Steroid treatment seems to benefit a subset of children with ventricular ectopic rhythm and a biopsy diagnosis of myocarditis or borderline treatable cause for the ventricular arrhythmia, endomyocardial biopsy is a valuable investigation in these patients.

Original languageEnglish (US)
Pages (from-to)354-359
Number of pages6
JournalHeart
Volume72
Issue number4
DOIs
StatePublished - 1994
Externally publishedYes

Fingerprint

Myocarditis
Immunosuppressive Agents
Biopsy
Cardiac Arrhythmias
Therapeutics
Ambulatory Electrocardiography
Ventricular Premature Complexes
Azathioprine
Adrenal Cortex Hormones
Steroids
Recurrence

ASJC Scopus subject areas

  • Gastroenterology
  • Cardiology and Cardiovascular Medicine

Cite this

Immunosuppressive treatment for myocarditis and borderline myocarditis in children with ventricular ectopic rhytm. / Balaji, Seshadri; Wiles, Henry B.; Sens, Mary Ann; Gillette, Paul C.

In: Heart, Vol. 72, No. 4, 1994, p. 354-359.

Research output: Contribution to journalArticle

Balaji, Seshadri ; Wiles, Henry B. ; Sens, Mary Ann ; Gillette, Paul C. / Immunosuppressive treatment for myocarditis and borderline myocarditis in children with ventricular ectopic rhytm. In: Heart. 1994 ; Vol. 72, No. 4. pp. 354-359.
@article{5882a3ad8721425dba1b9c8cca24df85,
title = "Immunosuppressive treatment for myocarditis and borderline myocarditis in children with ventricular ectopic rhytm",
abstract = "Objectives-To ascertain the responsiveness to immunosuppressive treatment of myocarditis and borderline myocarditis in children with ventricular ectopic rhythm (that is, all ventricular arrhythmia except benign premature ventricular contractions). To determine the impact of the diagnostic information provided by an endomyocardial biopsy specimen in these patients. Background-The therapeutic value of performing an endomyocardial biopsy in children with ventricular ectopic rhythm is not established. In turn, the treatment of myocarditis with immunosuppressive drugs is also controversial. Methods-The case notes and endomyocardial biopsy findings of all children with ventricular ectopic rhythm and a biopsy diagnosis of myocarditis were reviewed. Results-Ten (14{\%}) of 69 patients with ventricular ectopic rhythm and an anatomically normal heart had histological evidence of myocarditis or borderline myocarditis. Eight patients received corticosteroids and efficacy was judged by regular 24 hour Holter monitoring. Total resolution of arrhythmia was seen in four, improvement in two, and no change in two patients. At follow up (8-39 months, mean 22 months), arrhythmia recurrence was seen in the two patients who showed an improvement but not resolution during treatment. Both received azathioprine with fiurther reduction in ectopy rates. Patients who responded to treatment were symptomatic (six of six patients) at presentation compared with those who did not respond to treatment (none of two patients) who were not symptomatic. Five patients had a repeat biopsy specimen taken which confirmed histological impnrovemtent. Conclusions-Steroid treatment seems to benefit a subset of children with ventricular ectopic rhythm and a biopsy diagnosis of myocarditis or borderline treatable cause for the ventricular arrhythmia, endomyocardial biopsy is a valuable investigation in these patients.",
author = "Seshadri Balaji and Wiles, {Henry B.} and Sens, {Mary Ann} and Gillette, {Paul C.}",
year = "1994",
doi = "10.1136/hrt.72.4.354",
language = "English (US)",
volume = "72",
pages = "354--359",
journal = "Heart",
issn = "1355-6037",
publisher = "BMJ Publishing Group",
number = "4",

}

TY - JOUR

T1 - Immunosuppressive treatment for myocarditis and borderline myocarditis in children with ventricular ectopic rhytm

AU - Balaji, Seshadri

AU - Wiles, Henry B.

AU - Sens, Mary Ann

AU - Gillette, Paul C.

PY - 1994

Y1 - 1994

N2 - Objectives-To ascertain the responsiveness to immunosuppressive treatment of myocarditis and borderline myocarditis in children with ventricular ectopic rhythm (that is, all ventricular arrhythmia except benign premature ventricular contractions). To determine the impact of the diagnostic information provided by an endomyocardial biopsy specimen in these patients. Background-The therapeutic value of performing an endomyocardial biopsy in children with ventricular ectopic rhythm is not established. In turn, the treatment of myocarditis with immunosuppressive drugs is also controversial. Methods-The case notes and endomyocardial biopsy findings of all children with ventricular ectopic rhythm and a biopsy diagnosis of myocarditis were reviewed. Results-Ten (14%) of 69 patients with ventricular ectopic rhythm and an anatomically normal heart had histological evidence of myocarditis or borderline myocarditis. Eight patients received corticosteroids and efficacy was judged by regular 24 hour Holter monitoring. Total resolution of arrhythmia was seen in four, improvement in two, and no change in two patients. At follow up (8-39 months, mean 22 months), arrhythmia recurrence was seen in the two patients who showed an improvement but not resolution during treatment. Both received azathioprine with fiurther reduction in ectopy rates. Patients who responded to treatment were symptomatic (six of six patients) at presentation compared with those who did not respond to treatment (none of two patients) who were not symptomatic. Five patients had a repeat biopsy specimen taken which confirmed histological impnrovemtent. Conclusions-Steroid treatment seems to benefit a subset of children with ventricular ectopic rhythm and a biopsy diagnosis of myocarditis or borderline treatable cause for the ventricular arrhythmia, endomyocardial biopsy is a valuable investigation in these patients.

AB - Objectives-To ascertain the responsiveness to immunosuppressive treatment of myocarditis and borderline myocarditis in children with ventricular ectopic rhythm (that is, all ventricular arrhythmia except benign premature ventricular contractions). To determine the impact of the diagnostic information provided by an endomyocardial biopsy specimen in these patients. Background-The therapeutic value of performing an endomyocardial biopsy in children with ventricular ectopic rhythm is not established. In turn, the treatment of myocarditis with immunosuppressive drugs is also controversial. Methods-The case notes and endomyocardial biopsy findings of all children with ventricular ectopic rhythm and a biopsy diagnosis of myocarditis were reviewed. Results-Ten (14%) of 69 patients with ventricular ectopic rhythm and an anatomically normal heart had histological evidence of myocarditis or borderline myocarditis. Eight patients received corticosteroids and efficacy was judged by regular 24 hour Holter monitoring. Total resolution of arrhythmia was seen in four, improvement in two, and no change in two patients. At follow up (8-39 months, mean 22 months), arrhythmia recurrence was seen in the two patients who showed an improvement but not resolution during treatment. Both received azathioprine with fiurther reduction in ectopy rates. Patients who responded to treatment were symptomatic (six of six patients) at presentation compared with those who did not respond to treatment (none of two patients) who were not symptomatic. Five patients had a repeat biopsy specimen taken which confirmed histological impnrovemtent. Conclusions-Steroid treatment seems to benefit a subset of children with ventricular ectopic rhythm and a biopsy diagnosis of myocarditis or borderline treatable cause for the ventricular arrhythmia, endomyocardial biopsy is a valuable investigation in these patients.

UR - http://www.scopus.com/inward/record.url?scp=0028109785&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028109785&partnerID=8YFLogxK

U2 - 10.1136/hrt.72.4.354

DO - 10.1136/hrt.72.4.354

M3 - Article

C2 - 7833194

AN - SCOPUS:0028109785

VL - 72

SP - 354

EP - 359

JO - Heart

JF - Heart

SN - 1355-6037

IS - 4

ER -