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Multiple forms of sustained monomorphic ventricular tachycardia as common presentation in giant-cell myocarditis
  1. M Granér1,
  2. J Lommi1,
  3. M Kupari1,
  4. A Räisänen-Sokolowski2,
  5. L Toivonen1
  1. 1Department of Internal Medicine, Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
  2. 2Department of Pathology, Helsinki University Central Hospital, Helsinki, Finland
  1. Correspondence to:
    M Granér
    Department of Internal Medicine, Division of Cardiology, Helsinki University Central Hospital, Haartmaninkatu 4, FIN-00290 Huch, Finland; marit.graner{at}hus.fi

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Idiopathic giant-cell myocarditis (IGCM) is a rare and highly malignant form of inflammatory heart disease of unknown origin. Pathognomonic histological features are the presence of multinucleated giant cells and a widespread lymphocytic inflammatory infiltration in association with myocyte necrosis.1 IGCM predominantly affects previously healthy young and middle-aged people. Association with autoimmune disorders has been described in 19% of cases.2

Clinically, IGCM often shows a rapid onset of symptoms followed by a fulminant course resulting in congestive heart failure, progressive heart block and ventricular arrhythmias. The response to treatment is poor, and affected patients are often referred to cardiac transplantation.2

Although IGCM is highly associated with ventricular tachycardia,3 the features of ventricular arrhythmias have not been dealt with. We characterise the type of ventricular tachycardias, the recognition of which might initiate measures to promptly diagnose and treat IGCM.

METHODS

Clinical, electrocardiographic, echocardiographic and histopathological data were extracted from the medical records of nine patients diagnosed with IGCM in Helsinki University Hospital, Helsinki, Finland, between 1991 and 2004.

On the basis of electrocardiographic recordings and intracardiac electrophysiological studies, ventricular tachycardias were classified as monomorphic or polymorphic, and the morphological pattern of monomorphic ventricular tachycardia was categorised as right bundle branch block (RBBB) or left bundle branch block (LBBB), and superior or inferior axis in the frontal plane. In electrophysiological studies, programmed ventricular stimulation was carried out from …

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