IVIG May Improve Left Ventrical Function and Reduce Episodes of Arrhythmia in Adults with Acute Fulminant Myocarditis

Chinese investigators conducted an observational retrospective case study of inpatients presenting at Guangdong General Hospital with acute fulminant myocarditis (AFM) between January 2001 and December 2010. Inclusion criteria included adult age over18 years, acute onset (duration less than three months) congestive heart failure and impaired left ventricular function following a recent viral illness. Of 58 enrolled patients, 32 were administered intravenous immunoglobulin (IVIG) at a dose of 400 mg/kg for five days, along with other conventional therapies. The remaining patients, who were similar as a group with respect to baseline characteristics, received conventional therapies only.

The group receiving IVIG therapy had a higher left ventricular ejection fraction (LVEF) and a reduced left ventricular end-diastolic diameter (LVDD) compared with the non-IVIG therapy group four weeks subsequent to treatment (PLVEF = 0.011 and PLVDD = 0.048). While post-treatment incidence of ventricular tachycardia/ventricular fibrillation (VT/VF) and atrioventricular block (AVB) was reduced in the group receiving IVIG (PVT/VF = 0.025, PAVB = 0.003), no significant differences were seen in the non-IVIG group (PVT/VF = 0.564, PAVB = 0.083). Two and seven deaths occurred in the IVIG and non-IVIG groups, respectively (6% vs. 27%, P = 0.072).

The investigators concluded that IVIG therapy may be associated with improved recovery of left ventricular function and reduced episodes of fulminant arrhythmias.