Aim: To investigate relationship between frequent and complicated ventricular extrasystole (VE) in young patients and previous viral myocarditis (VM); to study VE long-term prognosis.
Material and methods: We examined 75 patients with mild and moderate myocarditis which developed after acute respiratory infections and other viral diseases (Coxsackie infection was serologically confirmed in 49%; flu, paraflu and adenoviral infection--in 8%). Acute myocarditis was diagnosed basing on the data of ECG, activity of cardiospecific enzymes and isoenzymes, x-ray, echocardiography, Holter ECG monitoring, exercise tests. The patients were followed up from 3 to 26 years (mean 14.6 years).
Results: Bigeminal polymorphic extrasystoles and bigemia sites persisted for the whole periods of observation. They could disappear at resting ECG but were registered at 24-h ECG monitoring in all the cases. Echocardiography detected fibrous alterations of the pericardium with its thickening in 89% cases. Exercise tolerance test at the end of the study recorded normal physical performance in 89.3% patients. This suggests a favorable disease outcome. Low physical performance, moderate dilation of the left ventricle and ejection fraction lowering to 48% requiring medication were observed only in 4 patients who were capable to work.
Conclusion: Frequent and complicated VE after viral myocarditis were present at resting ECG for many years in 42.3% patients. Holter 24-h ECG monitoring registered VE in all the examinees. 89% patients had fibrous lesions of the pericardium showing that viral myocarditis in most cases runs as myopericarditis, in some cases being subclinical.