@article{97cced3a395d49beae5dc5b2295cd5cd,
title = "Management of Patients With Giant Cell Myocarditis: JACC Review Topic of the Week",
abstract = "Giant cell myocarditis is a rare, often rapidly progressive and potentially fatal, disease due to T-cell lymphocyte-mediated inflammation of the myocardium that typically affects young and middle-aged adults. Frequently, the disease course is marked by acute heart failure, cardiogenic shock, intractable ventricular arrhythmias, and/or heart block. Diagnosis is often difficult due to its varied clinical presentation and overlap with other cardiovascular conditions. Although cardiac biomarkers and multimodality imaging are often used as initial diagnostic tests, endomyocardial biopsy is required for definitive diagnosis. Combination immunosuppressive therapy, along with guideline-directed medical therapy, has led to a paradigm shift in the management of giant cell myocarditis resulting in an improvement in overall and transplant-free survival. Early diagnosis and prompt management can decrease the risk of transplantation or death, which remain common in patients who present with cardiogenic shock.",
keywords = "cardiogenic shock, endomyocardial biopsy, giant cell myocarditis, heart block, heart failure, heart transplant, immunosuppression, left ventricular assist device, ventricular arrhythmia",
author = "Vigyan Bang and Sarju Ganatra and Shah, {Sachin P.} and Dani, {Sourbha S.} and Neilan, {Tomas G.} and Paaladinesh Thavendiranathan and Resnic, {Frederic S.} and Piemonte, {Thomas C.} and Ana Barac and Rushin Patel and Ajay Sharma and Rohan Parikh and Chaudhry, {Ghulam M.} and Mark Vesely and Hayek, {Salim S.} and Monika Leja and David Venesy and Richard Patten and Daniel Lenihan and Anju Nohria and Cooper, {Leslie T.}",
note = "Funding Information: Patients with advanced conduction system disease may require temporary pacing, frequently followed by permanent pacemaker implantation due to persistent bradyarrhythmias despite immunosuppression. In a Finnish registry, 17% of patients received permanent pacemaker implantation. Ventricular fibrillation or hemodynamically unstable VT may require antiarrhythmic medications such as amiodarone and/or ICD for secondary prevention, if meaningful survival >1 year is expected. ICD implantation for primary prevention should be pursued in those patients with LVEF <35%, despite at least 3 months of GDMT, with consideration of wearable cardiac defibrillators in the interim. Although consensus guidelines provide a Class IIa recommendation for primary prevention ICD implantation in patients with CS and extensive LGE on CMR in the absence of other indications (33), there is no clear evidence supporting such an approach in GCM. However, extrapolating from the recommendations for CS, in the absence of typical indications, ICD implantation could be considered on a case-by-case basis in GCM patients with extensive LGE on CMR despite adequate immunosuppressive therapy, particularly those with ventricular arrhythmias or ectopy on presentation or on ambulatory rhythm monitoring or those with high-grade fibrosis on EMB. In the Finnish registry, 57% of patients with GCM received an ICD (46% for primary prevention; 11% for secondary prevention) and 55% (17 of 31) received 1 or more appropriate therapies (ATP and/or shocks) for ventricular arrhythmias (6). Importantly, there were no reported device infections in the face of immunosuppression. Publisher Copyright: {\textcopyright} 2021 American College of Cardiology Foundation",
year = "2021",
month = mar,
day = "2",
doi = "10.1016/j.jacc.2020.11.074",
language = "English (US)",
volume = "77",
pages = "1122--1134",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "8",
}