Arrhythmogenic Inflammatory Cardiomyopathy: A Review

Arrhythmogenic inflammatory cardiomyopathy is a recent clinical description of a subgroup of patients with non-ischaemic cardiomyopathy who are referred to electrophysiologists for evaluation and management of ventricular arrhythmias and are found to have evidence of active cardiac inflammation. The identification of these patients is key, since the aetiology of their arrhythmic burden is likely both related to scar-mediated and direct inflammatory mechanisms, which may have different treatment approaches. Evaluation of these patients starts with a full clinical history and physical examination along with echocardiography, as with most patients with cardiomyopathy, however, additional imaging with fluorodeoxyglucose PET-CT and cardiac MRI is crucial. Medical treatment is aimed at targeting traditional neurohumeral mediators to achieve recovery of ejection fraction, in addition to immunosuppressant medication to directly treat inflammation. While medical treatment alone is successful in many patients, some will require further invasive management with electrophysiologic study and radiofrequency catheter ablation.