title: Myocardial Biopsy In "Idiopathic» Atrial Fibrillation And Other Arrhythmias: Nosological Diagnosis, Clinical And Morphological Parallels, And Treatment.
abstract: BACKGROUND
  The nosological nature of "idiopathic" arrhythmias and the effect of etiotropic and pathogenetic treatment are often unknown.
  
  
  RESULTS
  19 patients (42.6±11.3 years, 9 women) with atrial fibrillation (n = 16), supraventricular (n = 10) and ventricular (n = 4) premature beats, supraventricular (n = 2) and ventricular tachycardia (n = 1), left bundle branch block (n= 2), AV block (n = 2) without structural heart changes. Viruses were identified (polymerase chain reaction, PCR) along with measurement of anti-heart antibodies (AHA) and endomyocardial biopsy (EMB). EMB allowed to establish diagnosis in all patients: infectious-immune myocarditis (n = 11, parvovirus-positive in 1),parvovirus-positive endomyocarditis (n = 1),systemic (n = 2) and myocardial (n = 1) vasculitis,Fabry's disease (n = 1), arrhythmogenic right ventricular dysplasia (n = 1),unspecified genetic cardiomyopathy (n = 2, herpes virus 6 one positive). Level of AHA had the greatest significance for myocarditis diagnostics. All patients with myocarditis/vasculitis had background therapy: acyclovir (n = 10), IV immunoglobulin (n = 2), meloxicam (n = 12), hydroxychloroquine (n = 15), steroids (n = 14, 31.1±12.5 mg/day), azathioprine 150 mg/day (n = 2). Median follow-up was 4 years. Treatment significantly reduced the rate of arrhythmias (8 [5;8] to 3 [1.25;7.75] points); disappearance of bundle branch block was noted.
  
  
  CONCLUSIONS
  EMB allowed to diagnose immune-mediated inflammatory diseases in 78.9% patients with 'idiopathic' arrhythmias and genetic diseases in 21.1%. Background therapy of myocarditis improved the antiarrhythmic efficiency, and allowed the best premed for interventional treatment.
authors.affiliation: Sechenov First Moscow State Medical University 119992, Moscow, B.Pirogovskaya str., 6.
authors.forename: O V
authors.initials: OV
authors.lastname: Blagova
authors.affiliation: Sechenov First Moscow State Medical University 119992, Moscow, B.Pirogovskaya str., 6.
authors.forename: A V
authors.initials: AV
authors.lastname: Nedostup
authors.affiliation: Sechenov First Moscow State Medical University 119992, Moscow, B.Pirogovskaya str., 6.
authors.forename: E A
authors.initials: EA
authors.lastname: Kogan
authors.affiliation: Sechenov First Moscow State Medical University 119992, Moscow, B.Pirogovskaya str., 6.
authors.forename: V A
authors.initials: VA
authors.lastname: Sulimov
authors.affiliation: Petrovsky Russian Scientific Center of Surgery. RAMS.
authors.forename: S A
authors.initials: SA
authors.lastname: Abugov
authors.affiliation: humakov Scientific Center of Transplantation and Artificial Organs.
authors.forename: A G
authors.initials: AG
authors.lastname: Kupriyanova
authors.affiliation: humakov Scientific Center of Transplantation and Artificial Organs.
authors.forename: V A
authors.initials: VA
authors.lastname: Zaydenov
authors.affiliation: Kulakov Scientific Center for Obstetrics, Gynecology and Perinatology.
authors.forename: A E
authors.initials: AE
authors.lastname: Donnikov
authors.affiliation: Petrovsky Russian Scientific Center of Surgery. RAMS.
authors.forename: E V
authors.initials: EV
authors.lastname: Zaklyazminskaya
authors.affiliation: Sechenov First Moscow State Medical University 119992, Moscow, B.Pirogovskaya str., 6.
authors.forename: E A
authors.initials: EA
authors.lastname: Okisheva
keywords: Endomyocardial Biopsy; Idiopathic Arrhythmias; Immunosuppressive Therapy; Lone Atrial Fibrillation; Myocardial Vasculitis; Myocarditis