Treatment efficiency of arrhythmias of immune-inflammatory genesis by plasmapheresis
V.A. Kulikova¹, A.V. Nedostup¹, O.V. Blagova¹, V.A. Zaydenov², A.G. Kupriyanova³, I.A Nechaev⁴, A.A. Ragimov<sup>4

1</sup> Sechenov University, Moscow
² Shumakov National Medical Research Center of Transplantology and Artificial Organs, Moscow
³ Veltishchev Research Clinical Institute of Pediatrics, Moscow
⁴ Sechenov University Blood Center, Moscow

Aim: to study the effectiveness of plasmapheresis as the main type of pathogenetic treatment or in combination with immunosuppressive therapy in patients with arrhythmias of immune-inflammatory genesis.
Patients and Methods: 48 patients with an arrhythmic variant of myocarditis (with supraventricular/ventricular premature beats, atrial fibrillation) were included in the study. The inclusion criterion was an increase in ≥2 times of titers of at least 2 types of anti-cardiac antibodies. Myocarditis was diagnosed using myocardial biopsy, coronary angiography, a non-invasive diagnostic algorithm including anamnestic data, magnetic resonance imaging and multispiral computed tomography of the heart, myocardial scintigraphy. All patients underwent standard cardiotropic and anti-arrhythmic therapy. An additional course of discrete plasmapheresis was performed in 22 patients (the main group) with the removal of the thrombo-leukocyte layer and the total circulating plasma volume. The remaining 26 patients entered the experimental group. Dynamics of clinical and laboratory parameters were evaluated after 6 and 12 months.
Results: in the plasmapheresis group, a significant decrease in anti-cardiac antibody titers was observed immediately after plasmapheresis and during control studies (p<0.05). A good clinical response (decrease in the number of extrasystoles and atrial fibrillation frequency ≥75%) was observed in 81.2% of patients of the plasmapheresis group and 57.7% of the experimental group. In 32% of patients of the main group, it was possible to completely cancel the anti-arrhythmic therapy due to the persistent suppression of myocarditis activity, which was not achieved in the experimental group. The most significant effect was observed in patients with ventricular premature beats. The good response of plasmapheresis was associated with a shorter duration of the disease and younger patients. The predictor of plasmapheresis efficiency was the titer of a specific antinuclear factor (antibodies to the nuclei of cardiomyocytes) 1:40-1:80 and more. More aggressive therapy of myocarditis with methylprednisolone in patients of the main group was conducted significantly less frequently (46%) than in patients of the experimental group (73%), p<0.05. Methylprednisolone doses were also lower in the plasmapheresis patient group than in the experimental group (7[3.5; 16] vs. 16[10; 24] mg per day, respectively, p=0.055).
Conclusion: good clinical response to plasmapheresis was observed in 81.8% of patients with arrhythmias of immune-inflammatory genesis. In patients with the arrhythmic variant of myocarditis, plasmapheresis conduction increases the effectiveness of anti-arrhythmic and immunosuppressive therapy and makes it possible to refrain from aggressive immunosuppression regimens.

Key words: myocarditis, ventricular premature beats, supraventricular premature beats, atrial fibrillation, plasmapheresis, immunosuppressive therapy.
For citation: Kulikova V.A., Nedostup A.V., Blagova O.V. et al. Treatment efficiency of arrhythmias of immune-inflammatory genesis by plasmapheresis // RMJ. 2018. № 11(I). P. 18–26.