Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Mar 20;9(3):848.
doi: 10.3390/jcm9030848.

High Risk of Sustained Ventricular Arrhythmia Recurrence After Acute Myocarditis

Laurent Rosier  1 , Amir Zouaghi  2 , Valentin Barré  3 , Raphaël Martins  3 , Vincent Probst  4 , Eloi Marijon  5 , Nicolas Sadoul  6 , Samuel Chauveau  7 , Antoine Da Costa  8 , Marc Badoz  9 , Michael Peyrol  10 , Jérémie Barraud  10 , Grégoire Massoullie  11 , Romain Eschalier  11 , Madeline Espinosa  12 , François Lesaffre  12 , Rodrigue Garcia  13 , Bruno Degand  13 , Antoine Noël  14 , Jacques Mansourati  14 , Fabrice Extramiana  15 , Vincent Algalarrondo  15 , Hervé Devilliers  16 , Yves Cottin  1   17 , Estelle Gandjbakhch  2 , Charles Guenancia  1   17
Affiliations

High Risk of Sustained Ventricular Arrhythmia Recurrence After Acute Myocarditis

Laurent Rosier et al. J Clin Med. .

Abstract

Acute myocarditis is associated with cardiac arrhythmia in 25% of cases; a third of these arrhythmias are ventricular tachycardia (VT) or ventricular fibrillation (VF). The implantation of a cardiac defibrillator (ICD) following sustained ventricular arrhythmia remains controversial in these patients. We sought to assess the risk of major arrhythmic ventricular events (MAEs) over time in patients implanted with an ICD following sustained VT/VF in the acute phase of myocarditis compared to those implanted for VT/VF occurring on myocarditis sequelae. Our retrospective observational study included patients implanted with an ICD following VT/VF during acute myocarditis or VT/VF on myocarditis sequelae, from 2007 to 2017, in 15 French university hospitals. Over a median follow-up period of 3 years, MAE occurred in 11 (39%) patients of the acute myocarditis group and 24 (60%) patients of the myocarditis sequelae group. Kaplan-Meier MAE rate estimates at one and three years of follow-up were 19% and 45% in the acute group, and 43% and 64% in the sequelae group. Patients who experienced sustained ventricular arrhythmias during acute myocarditis had a very high risk of VT/VF recurrence during follow-up. These results show that the risk of MAE recurrence remains high after resolution of the acute episode.

Keywords: implantable cardioverter defibrillator; myocarditis; ventricular fibrillation; ventricular tachycardia.

PubMed Disclaimer

Conflict of interest statement

None: L.R., A.Z., V.B., R.M., V.P., N.S., S.C., A.D.C., M.B., M.P., G.M., R.E., M.E., F.L., R.G., B.D., A.N., J.M., H.D., Y.C.; E.M.: research grants from Abbott, Biotronik, Boston Scientific France, Microport, Medtronic France, Alliance BMS/Pfizer, Boehringer Ingelheim, ZOLL; J.B.: personal fees from Microport; V.A.: research grants from Abbott, Biotronik, Boston Scientific France, Microport, Medtronic France; F.E.: personal fees and non-financial support from Bayer, non-financial support from Biosense Webster, non-financial support from Biotronik, non-financial support from Boston Scientific, personal fees from Chiesi Pharmaceutical, personal fees from Daïchi-Sankyo, non-financial support from Medtronic, personal fees from Pfizer, non-financial support from Saint Jude Medical, personal fees and non-financial support from Sanofi, outside the submitted work; C.G.: research grants from Microport.

Figures

Figure 1
Figure 1
Study population.
Figure 2
Figure 2
Kaplan–Meier curve comparing survival without major arrhythmic event between acute myocarditis and myocarditis sequelae patients implanted with an ICD.
Figure 3
Figure 3
Distribution and treatment of major arrhythmic events (MAEs) in the two groups. VT: ventricular tachycardia, VF: ventricular fibrillation, ATP: antitachycardia pacing.
Figure 4
Figure 4
Kaplan–Meier curve comparing survival without major arrhythmic events in acute myocarditis patients with and without an ICD.
See this image and copyright information in PMC

References

    1. Anzini M., Merlo M., Sabbadini G., Barbati G., Finocchiaro G., Pinamonti B., Salvi A., Perkan A., Di Lenarda A., Bussani R., et al. Long-term evolution and prognostic stratification of biopsy-proven active myocarditis. Circulation. 2013;128:2384–2394. doi: 10.1161/CIRCULATIONAHA.113.003092. - DOI - PubMed
    1. Peretto G., Sala S., Rizzo S., De Luca G., Campochiaro C., Sartorelli S., Benedetti G., Palmisano A., Esposito A., Tresoldi M., et al. Arrhythmias in myocarditis: State of the art. Heart Rhythm. 2019;16:793–801. doi: 10.1016/j.hrthm.2018.11.024. - DOI - PubMed
    1. Priori S.G., Blomstrom-Lundqvist C., Mazzanti A., Blom N., Borggrefe M., Camm J., Elliott P.M., Fitzsimons D., Hatala R., Hindricks G., et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC) Eur. Heart J. 2015;36:2793–2867. doi: 10.1093/eurheartj/ehv316. - DOI - PubMed
    1. Al-Khatib S.M., Stevenson W.G., Ackerman M.J., Bryant W.J., Callans D.J., Curtis A.B., Deal B.J., Dickfeld T., Field M.E., Fonarow G.C., et al. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J. Am. Coll. Cardiol. 2018;72:1677–1749. doi: 10.1016/j.jacc.2017.10.053. - DOI - PubMed
    1. Grun S., Schumm J., Greulich S., Wagner A., Schneider S., Bruder O., Kispert E.M., Hill S., Ong P., Klingel K., et al. Long-term follow-up of biopsy-proven viral myocarditis: Predictors of mortality and incomplete recovery. J. Am. Coll. Cardiol. 2012;59:1604–1615. doi: 10.1016/j.jacc.2012.01.007. - DOI - PubMed