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Right ventricular endomyocardial biopsy in children and adolescents with drug-refractory arrhythmia

Published online by Cambridge University Press:  23 May 2016

Elena Vasichkina ,
Hermine Poghosyan ,
Lubov Mitrofanova ,
Roman Tatarsky  and
Dmitry Lebedev
Elena Vasichkina
Affiliation:
Cardiology Department, Almazov Federal Medical Research Center; St. Petersburg, Russia
Hermine Poghosyan*
Affiliation:
Cardiology Department, Astghik Medical Center, Yerevan, Armenia
Lubov Mitrofanova
Affiliation:
Cardiology Department, Almazov Federal Medical Research Center; St. Petersburg, Russia
Roman Tatarsky
Affiliation:
Cardiology Department, Almazov Federal Medical Research Center; St. Petersburg, Russia
Dmitry Lebedev
Affiliation:
Cardiology Department, Almazov Federal Medical Research Center; St. Petersburg, Russia
*
Correspondence to: H. Poghosyan, MD, Astghik Medical Center, 28/1 Daniel Varujan St, 0038 Yeravan, Armenia. Tel: +374 99 99 05 00; Fax: (+37410)773000; (+37410) 773458+316; E-mail: epdoctorh@gmail.com
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Abstract

Purpose

This study aimed to assess the results of endomyocardial biopsy from the right ventricle to establish the possible cause for drug-refractory arrhythmias in children.

Materials and methods

We enrolled 19 consecutive young patients with drug-refractory arrhythmia, from 2010 to 2013, who underwent endomyocardial biopsy. Inclusion criteria were as follows: age <18 years with a structurally normal heart or mild changes in a structure of the heart initially diagnosed as arrhythmia-induced cardiomyopathy. Overall, 86 biopsies were performed in 19 patients. Histopathological analysis, immunohistochemistry, and polymerase chain reaction were used for the interpretation of the endomyocardial biopsy.

Results

The mean age of the patient population was 14.1±2.9 year (range from 7 to 17 years). All these patients had a history of drug-refractory arrhythmia for >5 months (mean 30 months). Patients underwent a complete history investigation, physical examination, laboratory studies, echocardiography, electrocardiography, treadmill test, and Holter monitoring before endomyocardial biopsy; two patients with arrhythmogenic right ventricular dysplasia had implantable cardioverter defibrillator implantation and further appropriate successful device shocks. Myocarditis was diagnosed based on histopathological and immunohistological analyses in nine (47.4%) patients. Polymerase chain reaction was positive for viral genome in four of them; five patients had active myocarditis. Radiofrequency ablation was performed in 17 patients; five out of six (83%) endomyocardial biopsy-proved myocarditis patients had successful radiofrequency ablation. No significant complication was reported during ablation and endomyocardial biopsy.

Conclusions

Approximately half of the children with drug-refractory arrhythmia had unsuspected myocarditis according to the results of the endomyocardial biopsy.

Keywords

Endomyocardial biopsymyocarditisdrug-refractory arrhythmiachildren and adolescents
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 3 , March 2017 , pp. 435 - 442
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Copyright
© Cambridge University Press 2016 

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