Objective: It was our aim to study the outcome of autonomic nervous function (ANF), heart rate variability (HRV) and arrhythmias in patients with acute viral myocarditis in a 6-month follow-up period after the diagnosis. Methods: ANF was measured in patients with acute viral myocarditis 1, 3 and 6 months after the disease was diagnosed. HRV and arrhythmias were monitored by 24-hour electrocardiogram during the follow-up examination. Results: Ninety-six patients with acute viral myocarditis were enrolled in this study; 58% showed abnormal ANF tests, and the incidence was reduced to 17% after 6 months (p < 0.01). Time and frequency domain analyses of HRV were significantly reduced in the early stage of the disease and recovered after 6 months (p < 0.05). The incidence of arrhythmias in patients with abnormal ANF was significantly higher than in patients with normal ANF (p < 0.05). The incidence of arrhythmias in patients with abnormal ANF at 6 months was significantly lower than that at the first month (p < 0.05). Conclusions: There is a significant impairment of ANF and a higher incidence of arrhythmias in the early stage of acute myocarditis. ANF and HRV abnormalities are significantly improved, and the incidence of arrhythmia is significantly reduced after 6 months in patients with acute myocarditis.

Keywords:
Viral myocarditis, Autonomic nervous function, Heart rate variability, Arrhythmia, Ventricular tachycardia
1.
Morgera T, Lennada A, Dreas L, Pinamonti B, Humar F, Bussani R, Silvestri F, Chersevani D, Camerini F: Electrocardiography of myocarditis revisited: clinical and prognostic significance of electrocardiographic changes. Am Heart J 1992;124:455–467.
2.
Matsuura H, Palacios IF, Dec GW, Fallon JT, Garan H, Ruskin JN, Yasuda T: Intraventricular conduction abnormalities in patients with clinically suspected myocarditis are associated with myocardial necrosis. Am Heart J 1994;127:1290–1297.
3.
Cioc AM, Nuovo GJ: Histologic and in situ viral findings in the myocardium in cases of sudden, unexpected death. Mod Pathol 2002;15:914–922.
4.
Chu PL, Chang WT, Chen WJ, Chen YS: Acute viral myocarditis presenting as sudden cardiac arrest and refractory ventricular tachycardia. Am J Emerg Med 2004;22:628–629.
5.
Brady WJ, Ferguson JD, Ullman EA, Perron AD: Myocarditis: emergency department recognition and management. Emerg Med Clin North Am 2004;22:865–885.
6.
Wu ZK, Vikman S, Laurikka J, Pehkonen E, Iivainen T, Huikuri HV, Tarkka MR: Nonlinear heart rate variability in CABG patients and the preconditioning effect. Eur J Cardiothorac Surg 2005;28:109–113.
7.
Vikman S, Makikallio TH, Yli-Mayry S, Pikkujamsa S, Koivisto AM, Reinikainen P, Airaksinen KE, Huikuri HV: Altered complexity and correlation properties of R-R interval dynamics before the spontaneous onset of paroxysmal atrial fibrillation. Circulation 1999;100:2079–2084.
8.
Farrell TG, Paul V, Cripps TR, Malik M, Bennett ED, Ward D, Camm AJ: Baroreflex sensitivity and electrophysiological correlates in patients after acute myocardial infarction. Circulation 1991;83:945–952.
9.
Task Force on Myocarditis and Cardiomyopathy of Chinese Journal of Cardiology Editor Committee: Reference standards for diagnosis of acute viral myocardits in adults. Chin J Cardiology 1999;27:405–407.
10.
Wynne J, Braunwald E: The cardiomyopathies and myocarditides; in Braunwald E, Zipes DP, Libby P (eds): Heart Disease, ed 6. Philadelphia, Saunders, 2001, pp 1783–1793.
11.
Lawrence GP, Home PD, Murray A: Autonomic function testing in diabetic subjects using sequential measurements. Diabet Med 1992;9:799–805.
12.
De Becker P, Dendale P, De Meirleir K, Campine I, Vandenborne K, Hagers Y: Autonomic testing in patients with chronic fatigue syndrome. Am J Med 1998;105:22S–26S.
13.
Levi D, Alejos J: Diagnosis and treatment of pediatric viral myocarditis. Curr Opin Cardiol 2001;16:77–83.
14.
Calabrese F, Thiene G: Myocarditis and inflammatory cardiomyopathy: microbiological and molecular biological aspects. Cardiovasc Res 2003;60:11–25.
15.
Eckart RE, Scoville SL, Campbell CL, Shry EA, Stajduhar KC, Potter RN, Pearse LA, Virmani R: Sudden death in young adults: a 25-year review of autopsies in military recruits. Ann Intern Med 2004;141:829–834.
16.
Wisten A, Forsberg H, Krantz P, Messner T: Sudden cardiac death in 15- to 35-year olds in Sweden during 1992–99. J Intern Med 2002;252:529–536.
17.
Fontaine G, Fornes P, Fontaliran F: Myocarditis as a cause of sudden death. Circulation 2001;103:e12.
18.
Lecomte D, Fornes P, Fouret P, Nicolas G: Isolated myocardial fibrosis as a cause of sudden cardiac death and its possible relation to myocarditis. J Forensic Sci 1993;38:617–621.
19.
HRV Cooperation Study Group: Multicenter study of HRV’s normal field and its reproducibility. Chin J Cardiac Arrhyth 2000;4:165–170.
20.
Lazzara R: Arrhythmia mechanisms in the new millennium. J Interv Card Electrophysiol 2001;5:133–135.
21.
Gao XR, Zeng Q, Luo B: The changes of power spectral component of heart rate variability and its circadian rhythm in heart failure. Acad J Sun Yat-sen Univ Med Sci 2002;23:449–451.
22.
Kienzle MG, Ferguson DW, Birkett CL, Myers GA, Berg WJ, Mariano DJ: Clinical hemodynamic and sympathetic neural correlates of heart rate variability in congestive heart failure. Am J Cardiol 1992;69:761–767.
23.
Huikuri HV, Niemela MJ, Ojala S, Rantala A, Ikaheimo MJ, Airaksinen KE: Circadian rhythm of frequency domain measures of heart rate variability in healthy subjects and patients with coronary artery disease. Circulation 1994;90:121–126.
24.
Schauerte P, Scherlag BJ, Patterson E, Scherlag MA, Matsudaria K, Nakagawa H, Lazzara R, Jackman WM: Focal atrial fibrillation: experimental evidence for a pathophysiologic role of the autonomic nervous system. J Cardiovasc Electrophysiol 2001;12:592–599.
25.
Ravits JM: AAEM minimonograph #48: autonomic nervous system testing. Muscle Nerve 1997;20:919–937.
26.
Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology: Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation 1996;93:1043–1065.
27.
Cheng JD, Chen YC, Hu BJ: A quantitative study on peptidergic innervation in sinus node in cases of sudden death caused by myocarditis. Chin J Anat 2001;124:514–517.
28.
Nolte KB, Alakija P, Oty G, Shaw MW, Subbarao K, Guarner J, Shieh WJ, Dawson JE, Morken T, Cox NJ, Zaki SR: Influenza A virus infection complicated by fatal myocarditis. Am J Forensic Med Pathol 2000;21:375–379.
29.
Dettmeyer R, Sperhake JP, Madea B, et al: Cytomegalovirus-induced pneumonia and myocarditis in three cases of suspected sudden infant death syndrome (SIDS): diagnosis by immunohistochemical techniques and molecularpathologic methods. Forensic Sci Int 2008;174:229–233.
© 2008 S. Karger AG, Basel
2008
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.