Key result
Disease-specific therapy for atrial myocarditis in patients presenting with atrial fibrillation led to a non-significant improvement in LVEF from 45% to 56% (p=0.09).
Why the study?
Atrial myocarditis may be the cause of AF in patients without risk factors.
Does disease-specific therapy improve clinical status and imaging findings in patients with atrial myocarditis presenting with atrial fibrillation?
Observational (n=15)
Does disease-specific therapy improve clinical status and imaging findings in patients with atrial myocarditis presenting with atrial fibrillation?
Atrial myocarditis should be suspected in young individuals presenting with atrial fibrillation and stroke without conventional risk factors, as disease-specific therapy may improve clinical status and imaging findings.
Does not support routine use in atrial myocarditis with AF; leaves open efficacy of disease-specific therapy pending controlled trials.
Objectives We present a case series of patients with granulomatous myocarditis presenting as atrial arrhythmias accompanied by lymphadenopathy. Background Atrial myocarditis (AM) may be the cause of atrial fibrillation (AF) in patients without risk factors. Methods Patients with atrial fibrillation without risk factors underwent 18F‐Fluorodeoxyglucose positron emission tomography (18F‐FDG‐PET). We performed biopsy of lymph nodes or myocardium in patients with atrial uptake of 18F‐FDG‐PET. Results AM was observed in 15 patients. The median age of the patients was 42 years and left ventricular ejection fraction (LVEF) at presentation was 45%. All patients had AF, atrial flutter was noted in 4 patients (26.7%) and 2 patients (13.3%) had atrioventricular nodal reentrant tachycardia (AVNRT). 18F‐FDG‐PET uptake was noted in the atria in all patients and in the ventricles in 3 patients (20%). Cardiac sarcoidosis was the diagnosis in 12 patients (80%) while 3 patients (20%) had tuberculosis. The median CHA2DS2 VASc score was 1. Four patients (26.7%) presented with ischemic stroke. All patients were treated with disease‐specific therapy in addition to antiarrhythmic medications. Over a median follow up of 26 months, a significant improvement in clinical status commensurate with a decline in atrial uptake was noted. A non‐significant improvement in LVEF to 56% with disease‐specific therapy was observed. ( p = 0.09). Conclusion Atrial fibrillation with granulomatous lymphadenopathy may be a presenting feature of AM. The risk of stroke is high in these individuals. AM should be suspected in young individuals presenting with atrial fibrillation and stroke without conventional risk factors.
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Kumar et al. (2024) conducted an observational in Atrial myocarditis (n=15). Disease-specific therapy and antiarrhythmic medications was evaluated on Improvement in left ventricular ejection fraction (LVEF) (p=0.09). Disease-specific therapy for atrial myocarditis in patients presenting with atrial fibrillation led to a non-significant improvement in LVEF from 45% to 56% (p=0.09).
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