children with ventricular ectopic rhythm . myocarditis and borderline myocarditis in Immunosuppressive treatment for

Objectives-To ascertain the responsiveness to immunosuppressive treatment of myocarditis and borderline myocarditis in children with ventricular ectopic rhythm (that is, all ventricular arrhythmia except benign premature ventricular contractions). To determine the impact ofthe diagnostic information provided by an endomyocardial biopsy specimen in these patients. Background-The therapeutic value of performing an endomyocardial biopsy in children with ventricular ectopic rhythm is not established. In turn, the treatment of myocarditis with immunosuppressive drugs is also controversial. Methods-The case notes and endomyocardial biopsy findings of all children with ventricular ectopic rhythm and a biopsy diagnosis of myocarditis were reviewed. Results-Ten (14%) of 69 patients with ventricular ectopic rhythm and an anatomically normal heart had histological evidence of myocarditis or borderline myocarditis. Eight patients received corticosteroids and efficacy was judged by regular 24 hour Holter monitoring. Total resolution of arrhythmia was seen in four, improvement in two, and no change in two patients. At follow up (8-39 months, mean 22 months), arrhythmia recurrence was seen in the two patients who showed an improvement but not rt resolution during treatment. Both In of received azathioprine with fiurther reduciology, tion in ectopy rates. Patients who rsity of ,, responded to treatment were symptouth matic (six of six patients) at presentation compared with those who did not respond to treatment (none of two patients) who were not symptomatic. Five patients had a repeat biopsy specirt men taken which confirmed histological inofnt aical improvement. outh Conclusions-Steroid treatment seems to -leston, benefit a subset of children with t, USA ventricular ectopic rhythm and a biopsy ,. diagnosis of myocarditis or borderline myocarditis. Because it can identify a diatric treatable cause for the ventricular al Heart arrhythmia, endomyocardial biopsy is a [, Sydney valuable investigation in these patients. II oinr. cation (Br Heart 1994;72:354-359) Ventricular ectopic rhythm-that is, complex ventricular premature contractions, ventricular tachycardia, and ventricular fibrillation-is a rare but potentially serious problem in children. Most children with ventricular ectopic rhythm have congenital heart disease. Ventricular ectopic rhythm can, however, occur in children with no apparent structural heart disease. In a previous report we showed that such children may be found to have subclinical cardiomyopathy or unsuspected myocarditis when a endomyocardial biopsy sample is taken.' This report considers children with ventricular ectopic rhythm and myocarditis or borderline myocarditis with particular reference to management with immunosuppressive drugs. Patients and methods