High Risk of Sustained Ventricular Arrhythmia Recurrence After Acute Myocarditis

Rosier, L.; Zouaghi, Amir; Barré, Valentin; Martins, Raphaël P.; Probst, Vincent; Marijon, Éloi; Sadoul, Nicolas; Chauveau, Samuel; Costa, Antoine Da; Badoz, Marc; Peyrol, Michaël; Barraud, Jérémie; Massoullié, Grégoire; Eschalier, Romain; Espinosa, Marisa González Montero de; Lesaffre, François; Garcia, Rodrigue; Degand, Bruno; Noël, Antoine; Mansourati, Jacques; Extramiana, Fabrice; Algalarrondo, Vincent; Devilliers, H.; Cottin, Yves; Gandjbakhch, Estelle; Guenancia, Charles

doi:10.3390/jcm9030848

Cited by 20 publications

(13 citation statements)

References 27 publications

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“…As demonstrated by Peretto et al, these anatomopathological and arrhythmogenic differences clinically manifest themselves with two different arrhythmic patterns: polymorphic and irregular ventricular arrhythmias are more common during the active inflammatory phase, whereas monomorphic and regular ventricular arrhythmias, suggesting a static and “cold” substrate, are associated with healed myocarditis. Similarly, a French study found that ventricular fibrillation was the most common initial ventricular arrhythmia in acute myocarditis setting (58%), that ventricular tachycardia was the most common in myocarditis sequelae (78%), and that cardiorespiratory arrest was twice as frequent in the course of acute myocarditis (68 versus 30%) ( 75 ).…”

Section: Potential Mechanisms Of Arrhythmia In Myocarditismentioning

confidence: 98%

“…Indeed, data from the Multicenter Lombardy Registry showed that patients with complex ventricular arrhythmias at presentation were at higher risk of worse long-term outcomes than uncomplicated myocarditis cases that had, instead, benign long-term prognosis and low risk of subsequent arrhythmic events and left ventricular systolic dysfunction ( 30 ). Similarly, a French study ( 75 ) showed that patients presenting with ventricular tachycardia or ventricular fibrillation in the acute phase of myocarditis who had received ICD implantation early for secondary prevention had a very high risk (39%) of recurrence of major arrhythmic ventricular events (MAEs) over a median follow-up period of 3 years. In addition, an alarming 80% of patients in a study subgroup who preferred not to have ICD implantation experienced an MAE over time.…”

Section: Long-term Prognosis and Implantable Defibrillator Indication...mentioning

confidence: 99%

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Viral Myocarditis: Classification, Diagnosis, and Clinical Implications

Sozzi

Gherbesi

Faggiano

et al. 2022

Front. Cardiovasc. Med.

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Myocarditis is an inflammatory disease of the myocardium with focal or diffuse involvement. Viral infections are the most common cause of myocarditis, especially in Western countries. A recent viral illness with gastroenteric or upper respiratory symptoms often precedes myocarditis. The absence of specific pathognomonic features in conjunction with the wide spectrum of clinical manifestations that range from subclinical cases to sudden cardiac death (SCD) makes myocarditis diagnosis particularly challenging. Moreover, myocarditis might represent a cause of initially unexplained dilated cardiomyopathy (DCM) and heart failure (HF), especially among children and young adults. Cardiac magnetic resonance imaging (CMR) is crucial for myocarditis diagnosis, because of its ability to detect interstitial edema during acute inflammation. Assessment of subepicardial or mid-myocardial fibrosis by late gadolinium enhancement (LGE) is typical for myocarditis. Cardiac arrhythmias are frequent events that may arise especially in more severe myocarditis cases. The most common form of arrhythmia is atrial fibrillation, followed by ventricular tachycardia. Documented arrhythmias have been reported more commonly with HIV myocarditis than other more common infections such as Adenovirus, Parvovirus B19, human Herpes virus 6, and Enterovirus. The mechanisms of arrhythmogenesis in myocardial inflammation are not fully understood; in the acute phase, the spectrum of arrhythmogenesis ranges from a direct effect on cardiomyocytes that leads to electrical instability and ion channel impairment to ischemia from coronary macro- or microvascular disease. In chronic myocarditis, instead, myocardial replacement with fibrosis promotes scar-mediated re-entrant ventricular arrhythmias. Observational data suggested the important role of CMR, with LGE being the strongest independent predictor of SCD, cardiac, and all-cause mortality. In acute myocarditis, the most common localization of subepicardial LGE dwells in the lateral wall. Patients with myocarditis that develop HF and arrhythmias usually show a larger LGE distribution involving several myocardial segments. Moreover, a mid-layer LGE in the interventricular septum is more frequent in acute myocarditis than in acute coronary syndromes cases. The risk of SCD in patients with wide areas of LGE is significant, and a shared decision-making approach is warranted. Nevertheless, there is no formal consensus about the extension of LGE to justify implantable cardioverter defibrillator (ICD) implantation in primary prevention.

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Section: Potential Mechanisms Of Arrhythmia In Myocarditismentioning

confidence: 98%

Section: Long-term Prognosis and Implantable Defibrillator Indication...mentioning

confidence: 99%

Viral Myocarditis: Classification, Diagnosis, and Clinical Implications

Sozzi

Gherbesi

Faggiano

et al. 2022

Front. Cardiovasc. Med.

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“…In 2022, Sharifrazi and his research fellows proposed the concept of computer-aided diagnosis to try and address the inaccuracy in the diagnosis of myocarditis [ 4 ]. Moreover, little is known about the clinical progression of the disease and further studies are required in this area [ 31 , 32 ]. American Heart Association stated that timely diagnosis and treatment are crucial to the prognosis of patients with fulminant myocarditis in 2020.…”

Section: Discussionmentioning

confidence: 99%

Global, regional, and national burdens of myocarditis, 1990–2019: systematic analysis from GBD 2019

et al. 2023

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Objectives Myocarditis, a health-threatening heart disease, is attracting increasing attention. This systematic study was conducted to study the prevalence of disease through the trends of incidence, mortality, disability-adjusted life years (DALYs) over the last 30 years, which would be helpful for the policymakers to better the choices for reasonable decisions. Methods The global, regional, and national burdens of myocarditis from 1990–2019 were analyzed by using the 2019 Global Burden of Disease (GBD) database. This study on myocarditis produced new findings according to age, sex, and Social-Demographic Index (SDI) by investigating DALYs, age-standardized incidence rate (ASIR), age-standardized death rate (ASDR), and corresponding estimated annual percentage change (EAPC). Results The number of myocarditis incidence increased by 62.19%, from 780,410 cases in 1990 to 1,265,770 cases in 2019. The ASIR decreased by 4.42% (95%CI, from -0.26% to -0.21%) over the past 30 years. The number of deaths from myocarditis increased by 65.40% from 19,618 in 1990 to 324,490 in 2019, but the ASDR was relatively stable over the investigated period. ASDR increased in low-middle SDI regions (EAPC=0.48; 95%CI, 0.24 to 0.72) and decreased in low SDI regions (EAPC=-0.97; 95%CI, from -1.05 to -0.89). The age-standardized DALY rate decreased by 1.19% (95%CI, from -1.33% to -1.04%) per year. Conclusions Globally, the ASIR and DALY for myocarditis decreased and the ASDR was stable over the past 30 years. The risk of incidences and death cases increased with age. Measures should be taken to control the risk of myocarditis in high-burden regions. Medical supplies should be improved in the high-middle SDI regions and middle SDI regions to reduce the deaths from myocarditis in these regions.

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“…The risk of VT or sudden cardiac death following viral myocarditis can be as high as 50% in adults, likely from persistent inflammation or postinflammatory myocardial scar, highlighting the importance of follow‐up. 18 Cases of arrhythmias and sudden cardiac death have also been reported in children following myocarditis, including in patients with normal ventricular function. However, there is no good estimate of the risk, likely because of the rarity of events.…”

Section: Discussionmentioning

confidence: 99%

Tachyarrhythmias During Hospitalization for COVID‐19 or Multisystem Inflammatory Syndrome in Children and Adolescents

Dionne

Friedman

Young

et al. 2022

JAHA

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Background Cardiac complications related to COVID‐19 in children and adolescents include ventricular dysfunction, myocarditis, coronary artery aneurysm, and bradyarrhythmias, but tachyarrhythmias are less understood. The goal of this study was to evaluate the frequency, characteristics, and outcomes of children and adolescents experiencing tachyarrhythmias while hospitalized for acute severe COVID‐19 or multisystem inflammatory syndrome in children. Methods and Results This study involved a case series of 63 patients with tachyarrhythmias reported in a public health surveillance registry of patients aged <21 years hospitalized from March 15, 2020, to December 31, 2021, at 63 US hospitals. Patients with tachyarrhythmias were compared with patients with severe COVID‐19–related complications without tachyarrhythmias. Tachyarrhythmias were reported in 22 of 1257 patients (1.8%) with acute COVID‐19 and 41 of 2343 (1.7%) patients with multisystem inflammatory syndrome in children. They included supraventricular tachycardia in 28 (44%), accelerated junctional rhythm in 9 (14%), and ventricular tachycardia in 38 (60%); >1 type was reported in 12 (19%). Registry patients with versus without tachyarrhythmia were older (median age, 15.4 [range, 10.4–17.4] versus 10.0 [range, 5.4–14.8] years) and had higher illness severity on hospital admission. Intervention for treatment of tachyarrhythmia was required in 37 (59%) patients and included antiarrhythmic medication (n=31, 49%), electrical cardioversion (n=11, 17%), cardiopulmonary resuscitation (n=8, 13%), and extracorporeal membrane oxygenation (n=9, 14%). Patients with tachyarrhythmias had longer hospital length of stay than those who did not, and 9 (14%) versus 77 (2%) died. Conclusions Tachyarrhythmias were a rare complication of acute severe COVID‐19 and multisystem inflammatory syndrome in children and adolescents and were associated with worse clinical outcomes, highlighting the importance of close monitoring, aggressive treatment, and postdischarge care.

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High Risk of Sustained Ventricular Arrhythmia Recurrence After Acute Myocarditis

Cited by 20 publications

References 27 publications

Viral Myocarditis: Classification, Diagnosis, and Clinical Implications

Viral Myocarditis: Classification, Diagnosis, and Clinical Implications

Global, regional, and national burdens of myocarditis, 1990–2019: systematic analysis from GBD 2019

Tachyarrhythmias During Hospitalization for COVID‐19 or Multisystem Inflammatory Syndrome in Children and Adolescents

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