Clase I
1. La inserción de marcapaso temporal se indica en pacientes con bradicardia sintomática y/o bloqueo cardiaco durante la fase aguda de la miocarditis (Nivel de evidencia C).
2. La insuficiencia aórtica aguda asociada con taqui- cardia ventricular debería tratarse mediante cirugía, a menos que por otra situación esté contraindicada (Nivel de evidencia C).
3. La endocarditis aguda complicada con absceso aórtico o anular y bloqueo AV debería tratarse con ciru- gía a menos que otra situación lo contraindique (Nivel de evidencia C).
Clase IIa
1. La implantación de un cardiodesfibrilador puede ser beneficiosa en pacientes con arritmias ventriculares peligrosas que no hacen parte de la fase aguda de la miocarditis, como lo indican los consensos para implantación de marcapasos cardiacos y dispositivos antiarrítmicos, en quienes reciben terapia médica crónica y óptima, y en quienes tienen expectativa razonable de supervivencia, con un estado funcional bueno por más de un año (Nivel de evidencia C).
2. La terapia antiarrítmica puede ser útil en pacientes con taquicardia ventricular no sostenida, sintomáticos o con taquicardia ventricular sostenida durante la fase aguda de la miocarditis (Nivel de evidencia C).
Clase III
No se indica el implante de cardiodesfibrilador durante la fase aguda de la miocarditis (Nivel de evidencia C).
Miocardiopatías infi ltrativas
Clase I
Además del manejo de la miocardiopatía infiltrativa subyacente, las arritmias peligrosas deberían ser tratadas de la misma forma como se tratan pacientes con otras
miocardiopatías, incluyendo el uso de cardiodesfibrilador y marcapasos en quienes han recibido terapia médica crónica óptima y en quienes tienen expectativa razonable de sobrevida, con un buen estado funcional por más de un año (Nivel de evidencia C).
La asociación entre las miocardiopatías infiltrativas y la taquicardia ventricular-síndrome de muerte súbita está bien documentada. En todos los casos, un apropiado tratamiento de la condición subyacente, debería acom- pañar al manejo de las manifestaciones cardiacas.
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