Clinical Electrophysiology -> SVT/AVNRT/WPW/AT: -> Epidemiology of Cardiac Arrhythmias/ Epidemiology D-AB27 - Arrhythmias, infiltration and hypertrophy (ID 27) Abstract

D-AB27-05 - Granulomatous Atrial Cardiomyopathy Presenting With Atrial Arrhythmias And Mediastinal Lymphadenopathy (ID 1467)


Background: The clinical presentation and management of isolated atrial myocarditis have been rarely described.
Objective: We present a syndrome of atrial arrhythmias and granulomatous myocarditis accompanied by thoracic lymphadenopathy .
Methods: Twelve patients with atrial arrhythmias without standard risk factors for AF underwent CT and 18FDG PET-CT scans of the chest. Biopsy of either the lymph nodes or myocardium and tuberculosis (TB) testing was performed in all patients.
Results: The mean age of patients was 47±14.03 years with male predominance (66.6%). Patients with associated Ventricular arrhythmias were excluded. LV ejection fraction (EF) at presentation was 49.25±14.9% and LA size was 4 cm. All patients had AF at presentation, 6 patients had atrial flutter and 3 patients had AVNRT. Abnormal PET uptake in atrial myocardium without significant ventricular uptake was seen in all patients. Cardiac sarcoidosis (CS) was the diagnosis in 75% of the patients while 25% had evidence of tuberculo-sarcoidosis. 4 patients presented with ischemic stroke (33.3%). All patients were treated with immunosuppressive and or AT therapy. Over a mean follow up of 27 months, there was a significant improvement in clinical status and decrease in in atrial PET uptake in 75% of the patients and the EF also significantly improved to 56.58±13.36% (p=001).
Conclusion: Atrial arrhythmias with granulomatous lymphadenopathy and atrial inflammation may be a presenting feature of CS or TB. Risk of stroke is high in these patients despite low CHA2DS2 Vasc score. This syndrome should be suspected in young individuals presenting with atrial arrhythmias and stroke in the absence of conventional risk factors.