Detection of enteroviral RNA (poliovirus types 1 and 3) in endomyocardial biopsies from patients with ventricular tachycardia and survivors of sudden cardiac death.

The purpose of this study was to determine the prevalence of enteroviral infection in the myocardium of consecutive patients with serious ventricular arrhythmias by using a reverse transcription nested PCR followed by direct DNA sequencing. After exclusion of coronary heart disease, right ventricular endomyocardial biopsies were obtained from 32 consecutive patients with a history of ventricular tachycardia or sudden cardiac death. Control biopsies were obtained from 36 subjects with no history of viral myocarditis, dilated cardiomyopathy, ventricular tachycardia or recent infection. Enteroviral genome was found in endomyocardial biopsies from 4/32 patients (12.5%), 2 with a history of ventricular tachycardia and 2 with a history of ventricular fibrillation. Three of these 4 enteroviral RNA-positive patients had dilated cardiomyopathy and the other had normal cardiac geometry and ventricular function. In the latter and in 1 patient with enteroviral-positive dilated cardiomyopathy, an active inflammatory process in the myocardium was found by means of immunohistology. Enteroviral RNA in the myocardium of 3 patients had the highest homology to poliovirus type 1 (strain CHAT 10A-11) and in the other was similar to poliovirus type 3 (strain P3/119). All control samples were negative for enteroviral RNA. In summary, these findings raise the possibility that enteroviruses, such as poliovirus types 1 and 3, may be involved in the pathogenesis of ventricular tachycardia and sudden cardiac death.