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

Published version
Peer-reviewed

Type

Article

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Authors

Tse, G 
Yeo, JM 
Chan, YWF 
Lai, ETH 
Yan, BP 

Abstract

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.

Description

Keywords

viral myocarditis, cardiac arrhythmia, mouse model, viral-induced cardiomyopathy, conduction, repolarization

Journal Title

Frontiers in Physiology

Conference Name

Journal ISSN

1664-042X
1664-042X

Volume Title

7

Publisher

Frontiers Media
Sponsorship
GT was awarded a BBSRC Doctoral Training Award and thanks for the Croucher Foundation for its generous support.