Idiopathic Rhythm Disturbances - symptoms of subclinical myocarditis?

[RVVq]

I recently came across an interesting article in a European Electrophysiology journal. Here's the abstract in English:

«Idiopathic» arrhythmias as a symptom of latent cardiac disease: nosologic diagnostics
using endomyocardial biopsy

Endomyocardial biopsy of right ventricle was carried out in 16 patients with «idiopathic» rhythm disturbances (mainly atrial fibrillation, but also premature ventricular and atrial beats, paroxysmal tachycardias, various conduction disturbances and their combinations). Elevated levels of anti-myocardial antibodies, antibodies to antigens of endothelium, cardiomyocytes, conductive system and also (in some patients) identification of antinuclear factor with bull’s heart antigen (in absence of other laboratory markers) were
considered as additional indications for biopsy. Normal histological picture was not received in any cases. Noninflammatory abnormalities were diagnosed in 87.5% of patients (myocarditis — in 10 patients, virus cardiomyopathy — in 1 patient, endomyocarditis — in 1 patient, systemic vasculitis — in 2 patients); virus genome was detected in myocardium of 3 patients (herpes simplex virus type 6, parvovirus B19); 2 patients had arrhythmogenic right ventricular dysplasia and Fabry disease respectively. Specific treatment was started.

The study examined 16 patients young patients with idiopathic heart rhythm disturbances.  Most of them had lone AF, PVC, PAC, and SVT.  All patients had normal 'structurally normal hearts' according to ECHO, ECG and MRI. Hence, there arrhythmias were termed 'idiopathic' (no known cause).  Myocardial biopsy (removal of heart tissue for examination in the lab) was carried out in all the patients.  NOT A SINGLE PATIENT HAD A NORMAL HEART. Almost 90% of all patients had either viral myocarditis (viral inflammation of the heart), endocarditis, cardiomyopathy and vasculitis (inflammation of cardiac blood vessels).  3 Patients had other viruses in their hearts (herpes simplex virus type 6, parvovirus B19). The other 2 patients had 2 patients had arrhythmogenic right ventricular dysplasia and Fabry disease respectively.

This is a very important information for all people with idiopathic rhythm disturbances.  It challenges the notion that frequent arrhythmias are possible in healthy hearts.  It also raises awareness of frequency of sublinical heart disease.  Many of us might have chronic heart infections which are responsible for our rhythm disturbances, yet we think that we a 'healthy heart' that just decided to act up.  

I encourage all the readers of this forum to share this information with your doctors and to ask them questions.  

[MichelleP_3811]

I guess what I find interesting is medical community states that pvcs won't get worse yet mine are.  I never had them as persistant as I do now though that may be due to the svt making them worse and now that it is cleared up the pvcs won't get worse from here forward.  Time will tell.  But obviously as a sufferer when you have shortness of breath, trouble eating, chest pain and your heart stopping and starting thousands of time a day it is hard to be convinced it won't have an affect on the heart in the long run.  So I am glad at least someone is trying to study them.  Regardless of their malignant or benign nature no one should have to live like this every day of their lives.

[rilesnic]

I find I do feel better (heart better:) when I take an advil in the morning, especially if I am having runs of PVC's (with runs of PAC's I have to use the ice water trick)....I've said this before..hence the auto-immune...advil does have anit-inflammatory properties. I appreciate you sharing the article. No, I wouldn't voluntarily have a heart biopsy, but it does shed some light on what I've thought in the back of my mind. I already have just enough information to scare me heart silly, but nursing school did that to me, not this forum.

[RVVq]

Thank you for your comments.

I do not intend on teaching cardiologists on how to their job nor I intend to scare anyone here. I am just sharing this information, and my interpretation of it, with the rest of the forum members.  I am glad that my post are generating discussion.

I am well aware of the limitation of this study.  Its far from perfect, it would greatly benefit from a control group.  But really, what healthy person would volunteer for a cardiac biopsy?  Nevertheless, it comes up with an interesting conclusions that common idiopathic arrhythmias in people with 'structural normal hearts' could be caused by heart infections.  I don't think that everyone who gets these arrhythmias has myocarditis, but that could be the case in large subset of patients.

My point of sharing this information is to raise awareness of the possible causes of arrhythmias.  I don't think that there are enough longitudinal studies being done to examine the impact of frequent ectopic beats. The Italian study I mentioned in my first post is a rare example.  It came to a conclusion that PVCs don't usually progress into more serious arrhythmias.  Only one man out of 65 people examined developed VT.

The only way we would be able to find a cure for ectopic beats is to examine the mechanisms of their induction. This is one of the VERY few studies I came across which actually proposes a possible mechanism for PVC/PAC/Afib in people with structurally normal hearts.

And if you think that you cardiologists know all these studies you are wrong.  Based on my personal experience, a lot of doctors have very limited knowledge on this subject, as ectopics are considered to be benign and insignificant. I think that we as sufferers should raise awareness of the problem to the medical community.  Hopefully that will raise interest in subject which will translate into more studies and possibly better treatment options.  If the medical community will continue disregarding high frequency ectopics as completely benign there will be little research into the subject and no hope for a cure.  

I would love to see the follow-up study to the one I mentioned above.  They began treating all the 16 patients with anti-inflamotory steroids.  Now if that reduces or eliminates their arrhythmias, I would consider it to be a mini-breakthrough.  We should be glad that even small and flawed studies like that are conducted.

Best wishes to everyone!

[erijon]

This article is taken completely out of context. If you Google the data it is a small piece of a large work that is centered around a study of only 16 individuals, way too small to draw any clinical significance. There is nothing I read that would make me advise people to go running to their cardiologists with this information. There really is nothing new here when you read the peice as a whole.

Your concern is appreciated, but I don't see the same urgency as you do here.

Jon

[is_something_wrong]

Sorry to ask, but why do you keep posting articles that are drawn completely out of their context?

Of course, every (benign) arrhythmia has a cause. There is no such thing as "idiopathic" and coincidences don't exist. They are just causalities we still don't know or understand.

In the beginning of any infection in your body, you will get a slight myocarditis. That's the reason why you should NOT exercise while having a cold or a flu. Viruses will spread through the body and affect every organ. If you have a headache with a cold, that's actually a slight meningitis, but still it's not dangerous.

Every day, almost 100 beginning cancers appear in the body, but the immune system defeats them. The body have a superior ability to heal itself from the millions of threats we are exposed to daily, such as infections, pollution, radiation, poison, etc.

What is a "normal" heart? A heart without a single virus? I bet if you did biopsy of 16 hearts with no arrhythmias, you would still find a lot of viruses.

I think it's a very bad idea to try to teach cardiologists how to do their job. I would never do so. And I think it's an even worse idea what you do here, to scare the daylight out of healthy people, many with anxiety about their hearts.

Do you really think cardiologists aren't updated on this content?

I stick to the fact that serious heart events are extremely uncommon in people with normal hearts, normal after EKG and echo criteria.

[RVVq]

The patients were treated with anti-inflammatory steroids.  However, there's no standard treatment for myocarditis and we don't know if it can be cured.  I wish the study would be in English, so I could share the whole info with everyone.  I think all of us should share this information with our doctors.  Its important for them to know that, since I find that many doctors don't know enough about causes of arrhythmias!

Most people who suffer from ectopic beats notice a cyclical nature of the frequency of their ectopics.  They tend to wax and wane.  They can dissapear for a long time, for no apparent reason, only to strike back with a vengeance when you least expect them. SO FAR I NEVER HERD OF A SINGLE SCIENTIFIC THEORY WHICH EXPLAINED THAT CYCLICAL NATURE.  

The viral/auto-immune theory offers a perfect explanation to ectopic cycles. All chronic infections have a tendency to go into remission and flare up at seeming unexpected times.  Viral colonies have their own life cycles which are poorly understood.  

I ADVICE YOU TO SHARE THIS INFORMATION WITH ALL OF YOUR DOCTORS.  I BELIEVE IT IS OF PARAMOUNT IMPORTANCE!

Good luck!

[rilesnic]

Wow! Thanks for sharing this information. I have always thought it could be some type of auto-immune disease going on. I've had the flu twice since I've had ectopics, and both times, I didn't feel a single one, however, I was recently very ill with strep, ear infections, and whatever else my students sneezed and coughed onto me, and felt horrible (heart horrible) for a little over a month. I'm just now starting to feel somewhat back to normal (as normal as I can be with crazy heart beats). Did it say how these patients were treated?

[RVVq]

Keep in mind that when doctors tell you that everyone has PVCs and PACs, technically they are right. HOWEVER, its important to remember that only 1 percent of all healthy young people have more than 50 PVCs per day and similarly only 1 percent of all people have more than 100 PACs per day.  Yes almost everyone has some PVCs and PACs on a daily basis, BUT FREQUENT ECTOPIC BEATS ARE STATISTICALLY UNCOMMON and MIGHT BE INDICATIVE OF SUB-CLINICAL HEART DISEASE OR HEART INFECTION!