CORRESPONDENCE: LETTER TO THE EDITOR
Is it Myocarditis or Arrhythmogenic Right Ventricular Cardiomyopathy?
Boban Thomas, MD* and
Nuno Jalles Tavares, MD
* HNSR, Caselas MR Center, Rua Carolina Angelo, Lisbon 1400-045, Portugal (Email: bobantho{at}gmail.com).
Pieroni et al. (1) conclude that right ventricular myocarditis frequently mimics arrhythmogenic right ventricular cardiomyopathy (ARVC), and 3-dimensional electroanatomic mapping (guided endomyocardial biopsy is a tool that can differentiate the 2 entities, guiding appropriate therapy. The gist of their message suggests that these 2 entities are mutually exclusive, and in their cohort, electrocardiographic abnormalities, arrhythmias, right ventricular structural and functional abnormalities, Task Force criteria fulfillment, a 3-dimensional voltage map, and inducible arrhythmias on electrophysiologic testing could not separate the wheat from the chaff. Some experts have suggested that a "hot phase" may interpolate periods of clinical quiescence, and the former may present as myocarditis or worsening ventricular arrhythmia (2). If we were to acknowledge the possibility of this alternative hypothesis, the findings may be interpreted differently. The 15 patients who were diagnosed with myocarditis may represent a hot phase, and although they did not have fibrofatty changes, they fulfilled Task Force criteria, which are quite specific for the diagnosis of the disease. These patients with myocarditis may represent an earlier phase of the disease, and the observation that none of these patients experienced arrhythmic events gives credence to this possibility. Genetic testing in this sample would have been highly desirable even though it is not considered necessary for diagnosis by the authors. We agree with the authors that a revision and reappraisal of diagnostic criteria for ARVC is long overdue.
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1. Pieroni M, Dello Russo A, Marzo F, et al. High prevalence of myocarditis mimicking arrhythmogenic right ventricular cardiomyopathy: differential diagnosis by electroanatomic mapping-guided endomyocardial biopsy J Am Coll Cardiol 2009;53:681-689.[Abstract/Free Full Text]2. Sen-Chowdhry S, Syrris P, McKenna WJ. Desmoplakin disease in arrhythmogenic right ventricular cardiomyopathy: early genotype-phenotype studies Eur Heart J 2005;26:1582-1584.[Free Full Text]
Related Article
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Reply
- Maurizio Pieroni, Francesca Marzo, Fulvio Bellocci, and Filippo Crea
J. Am. Coll. Cardiol. 2009 54: 665-666.
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