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What Is the Arrhythmic Substrate in Viral Myocarditis? Insights from Clinical and Animal Studies

Sudden cardiac death (SCD) remains an unsolved problem in the twenty-first century. It is often due to rapid onset, ventricular arrhythmias caused by a number of different clinical conditions. A proportion of SCD patients have identifiable diseases such as cardiomyopathies, but for others, the cause...

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Autores principales: Tse, Gary, Yeo, Jie M., Chan, Yin Wah, Lai, Eric T. H. Lai, Yan, Bryan P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4954848/
https://www.ncbi.nlm.nih.gov/pubmed/27493633
http://dx.doi.org/10.3389/fphys.2016.00308
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author Tse, Gary
Yeo, Jie M.
Chan, Yin Wah
Lai, Eric T. H. Lai
Yan, Bryan P.
author_facet Tse, Gary
Yeo, Jie M.
Chan, Yin Wah
Lai, Eric T. H. Lai
Yan, Bryan P.
author_sort Tse, Gary
collection PubMed
description Sudden cardiac death (SCD) remains an unsolved problem in the twenty-first century. It is often due to rapid onset, ventricular arrhythmias caused by a number of different clinical conditions. A proportion of SCD patients have identifiable diseases such as cardiomyopathies, but for others, the causes are unknown. Viral myocarditis is becoming increasingly recognized as a contributor to unexplained mortality, and is thought to be a major cause of SCD in the first two decades of life. Myocardial inflammation, ion channel dysfunction, electrophysiological, and structural remodeling may play important roles in generating life-threatening arrhythmias. The aim of this review article is to examine the electrophysiology of action potential conduction and repolarization and the mechanisms by which their derangements lead to triggered and reentrant arrhythmogenesis. By synthesizing experimental evidence from pre-clinical and clinical studies, a framework of how host (inflammation), and viral (altered cellular signaling) factors can induce ion electrophysiological and structural remodeling is illustrated. Current pharmacological options are mainly supportive, which may be accompanied by mechanical circulatory support. Heart transplantation is the only curative option in the worst case scenario. Future strategies for the management of viral myocarditis are discussed.
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spelling pubmed-49548482016-08-04 What Is the Arrhythmic Substrate in Viral Myocarditis? Insights from Clinical and Animal Studies Tse, Gary Yeo, Jie M. Chan, Yin Wah Lai, Eric T. H. Lai Yan, Bryan P. Front Physiol Physiology Sudden cardiac death (SCD) remains an unsolved problem in the twenty-first century. It is often due to rapid onset, ventricular arrhythmias caused by a number of different clinical conditions. A proportion of SCD patients have identifiable diseases such as cardiomyopathies, but for others, the causes are unknown. Viral myocarditis is becoming increasingly recognized as a contributor to unexplained mortality, and is thought to be a major cause of SCD in the first two decades of life. Myocardial inflammation, ion channel dysfunction, electrophysiological, and structural remodeling may play important roles in generating life-threatening arrhythmias. The aim of this review article is to examine the electrophysiology of action potential conduction and repolarization and the mechanisms by which their derangements lead to triggered and reentrant arrhythmogenesis. By synthesizing experimental evidence from pre-clinical and clinical studies, a framework of how host (inflammation), and viral (altered cellular signaling) factors can induce ion electrophysiological and structural remodeling is illustrated. Current pharmacological options are mainly supportive, which may be accompanied by mechanical circulatory support. Heart transplantation is the only curative option in the worst case scenario. Future strategies for the management of viral myocarditis are discussed. Frontiers Media S.A. 2016-07-21 /pmc/articles/PMC4954848/ /pubmed/27493633 http://dx.doi.org/10.3389/fphys.2016.00308 Text en Copyright © 2016 Tse, Yeo, Chan, Lai and Yan. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Physiology
Tse, Gary
Yeo, Jie M.
Chan, Yin Wah
Lai, Eric T. H. Lai
Yan, Bryan P.
What Is the Arrhythmic Substrate in Viral Myocarditis? Insights from Clinical and Animal Studies
title What Is the Arrhythmic Substrate in Viral Myocarditis? Insights from Clinical and Animal Studies
title_full What Is the Arrhythmic Substrate in Viral Myocarditis? Insights from Clinical and Animal Studies
title_fullStr What Is the Arrhythmic Substrate in Viral Myocarditis? Insights from Clinical and Animal Studies
title_full_unstemmed What Is the Arrhythmic Substrate in Viral Myocarditis? Insights from Clinical and Animal Studies
title_short What Is the Arrhythmic Substrate in Viral Myocarditis? Insights from Clinical and Animal Studies
title_sort what is the arrhythmic substrate in viral myocarditis? insights from clinical and animal studies
topic Physiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4954848/
https://www.ncbi.nlm.nih.gov/pubmed/27493633
http://dx.doi.org/10.3389/fphys.2016.00308
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