title: ECG findings in comparison to cardiovascular MR imaging in viral myocarditis.
abstract: OBJECTIVE
  We sought (1) to assess prevalence and type of ECG abnormalities in patients with biopsy proven myocarditis and signs of myocardial damage indicated by LGE, and (2) to evaluate whether ECG abnormalities are related to the pattern of myocardial damage.
  
  
  BACKGROUND
  Prevalence and type of ECG abnormalities in patients presenting biopsy proven myocarditis, as well as any relation between ECG abnormalities and the in vivo pattern of myocardial damage are unknown.
  
  
  METHODS
  Eighty-four consecutive patients fulfilled the following criteria: (1) newly diagnosed biopsy proven viral myocarditis, and (2) non-ischemic LGE, and (3) standard 12-lead-ECG upon admission.
  
  
  RESULTS
  Sixty-five patients with biopsy proven myocarditis had abnormal ECGs upon admission (77%). In this group, ST-abnormalities were detected most frequently (69%), followed by bundle-branch-block in 26%, and Q-waves in 8%. Atrial fibrillation was present in 6%, and AV-Block in two patients. In patients with septal LGE ST-abnormalities were more frequently located in anterolateral leads compared to patients with lateral LGE, in whom ST-abnormalities were most frequently observed in inferolateral leads. Bundle-branch-block occurred more often in patients with septal LGE (11/17). Four of five patients with Q-waves had severe and almost transmural LGE in the lateral wall.
  
  
  CONCLUSIONS
  ECG abnormalities can be found in most patients with biopsy proven viral myocarditis at initial presentation. However, similar to suspected acute myocardial infarction, a normal ECG does not rule out myocarditis. ECG findings are related to the amount and area of damage as indicated by LGE, which confirms the important clinical role of ECG.
authors: Division of Cardiology, Robert-Bosch-Hospital, Stuttgart, Germany.
authors: Claudia C
authors: CC
authors: Deluigi
authors: Peter
authors: P
authors: Ong
authors: Stephan
authors: S
authors: Hill
authors: Anja
authors: A
authors: Wagner
authors: Eva
authors: E
authors: Kispert
authors: Karin
authors: K
authors: Klingel
authors: Reinhard
authors: R
authors: Kandolf
authors: Udo
authors: U
authors: Sechtem
authors: Heiko
authors: H
authors: Mahrholdt
mesh_terms: D004562:Electrocardiography / Q000592:standards*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000592:standards*; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D014777:Virus Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*