Post‐discharge arrhythmic risk stratification of patients with acute myocarditis and life‐threatening ventricular tachyarrhythmias
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Aims: The outcomes of patients presenting with acute myocarditis and life‐threatening ventricular arrhythmias (LT‐VA) are unclear. The aim of this study was to assess the incidence and predictors of recurrent major arrhythmic events (MAEs) after hospital discharge in this patient population. Methods and results: We retrospectively analysed 156 patients (median age 44 years; 77% male) discharged with a diagnosis of acute myocarditis and LT‐VA from 16 hospitals worldwide. Diagnosis of myocarditis was based on histology or the combination of increased markers of cardiac injury and cardiac magnetic resonance (CMR) Lake Louise criteria. MAEs were defined as the relapse, after discharge, of sudden cardiac death or successfully defibrillated ventricular fibrillation, or sustained ventricular tachycardia (sVT) requiring implantable cardioverter‐defibrillator therapy or synchronized external cardioversion. Median follow‐up was 23 months [first to third quartile (Q1–Q3) 7–60]. Fifty‐eight (37.2%) patients experienced MAEs after discharge, at a median of 8 months (Q1–Q3 2.5–24.0 months; 60.3% of MAEs within the first year). At multivariable Cox analysis, variables independently associated with MAEs were presentation with sVT [hazard ratio (HR) 2.90, 95% confidence interval (CI) 1.38–6.11]; late gadolinium enhancement involving ≥2 myocardial segments (HR 4.51, 95% CI 2.39–8.53), and absence of positive short‐tau inversion recovery (STIR) (HR 2.59, 95% CI 1.40–4.79) at first CMR. Conclusions: Among patients discharged with a diagnosis of myocarditis and LT‐VA, 37.2% had recurrences of MAEs during follow‐up. Initial CMR pattern and sVT at presentation stratify the risk of arrhythmia recurrence.
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The incidence of sudden cardiac death from acute myocarditis in young adults is about 6% to 10%.
“given an incidence of about 6% to 10% of sudden cardiac death from acute myocarditis in young adults.”
From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [256]
The Introduction says sudden cardiac death is a possible outcome of acute myocarditis, but gives no incidence estimate. The Study population and Outcome sections concern patients who presented with life-threatening ventricular arrhythmias, not sudden-death incidence in young adults. Searches for the 6%–10% figure and for young adults found no passage supporting the claimed estimate. (LLM, conf=0.77)
Experimental — accuracy not yet measuredIn fulminant myocarditis, severe conduction abnormalities such as second- and third-degree atrioventricular blocks are common.
“In fulminant myocarditis, severe conduction abnormalities such as second- and third-degree atrioventricular blocks are common”
From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [256]
The Introduction describes fulminant myocarditis in terms of severe haemodynamic compromise, while the arrhythmic risk stratification section discusses life-threatening ventricular arrhythmias. Neither passage addresses how common second- or third-degree atrioventricular block is in fulminant myocarditis. Searches for those blocks and for conduction abnormalities found no relevant passage in our copy. (LLM, conf=0.75)
Experimental — accuracy not yet measured
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M’Rabet, S., Kabore, E., Rav-Acha, M., Ng, C. Y., Gentile, P., Merlo, M., Pinnacchio, G., Deville, L., Bénali, K., Narducci, M. L., et al. (2026) · Heart Rhythm · doi:10.1016/j.hrthm.2026.03.1952
Self-citationMyocarditis Prognostic Score: A New Risk Assessment Tool
Lisi, D. D., Madaudo, C., Macaione, F., Castro, F., Bongiorno, F., Stabile, F. A., Micarelli, A., Galassi, A. R., & Novo, G. (2026) · Journal of Cardiovascular Development and Disease · doi:10.3390/jcdd13060223
Viêm cơ tim: Vai trò của cộng hưởng từ tim (CMR) trong chẩn đoán và tiên lượng
Hà, B. V., Hạnh, V. Đ., & Hoài, N. T. T. (2026) · Tạp chí Tim Mạch Học Việt Nam · doi:10.58354/jvc.121.2026.1308
Moady, G., Yanko, E., Levi-Gofman, L., Grosbard, D., & Atar, S. (2026) · Reviews in Cardiovascular Medicine · doi:10.31083/rcm48707
Acute Myocarditis: From Pathophysiology to Risk‐Stratified Management—A Clinical Review
Golino, M., Buono, M. G. D., Abbate, A., Potere, N., Bonaventura, A., Vecchié, A., Malandrino, D., Emmi, G., Kron, J., & Abbate, A. (2026) · European Journal of Clinical Investigation · doi:10.1111/eci.70247
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Self-citation
- Authors
- Gentile, P., Merlo, M., Peretto, G., Ammirati, E., Sala, S., Della Bella, P., Aquaro, G. D., Imazio, M., Potena, L., Campodonico, J., Foà, A., Raafs, A., Hazebroek, M., Brambatti, M., Cercek, A. C., Nucifora, G., Shrivastava, S., Huang, F., Schmidt, M., Muser, D., Van de Heyning, C. M., Van Craenenbroeck, E., Aoki, T., Sugimura, K., Shimokawa, H., Cannatà, A., Artico, J., Porcari, A., Colopi, M., Perkan, A., Bussani, R., Barbati, G., Garascia, A., Cipriani, M., Agostoni, P., Pereira, N., Heymans, S., Adler, E. D., Camici, P. G., Frigerio, M., & Sinagra, G.
- Affiliations
- University of Trieste (IT)
- Vita-Salute San Raffaele University (IT)
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT)
- Department of Cardiac Electrophysiology and Arrhythmology IRCCS San Raffaele Hospital and Vita‐Salute University Milan Italy
- Fondazione Toscana Gabriele Monasterio (IT)
- Ospedale Santa Maria della Misericordia di Udine (IT)
- IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT)
- University of Milan (IT)
- Maastricht University Medical Centre (NL)
- University of California San Diego (US)
- Department of Cardiology University Medical Centre Ljubljana Ljubljana Slovenia
- Flinders University (AU)
- Mayo Clinic (US)
- Hôpital Foch (FR)
- Sorbonne Université (FR)
- University of Udine (IT)
- Department of Cardiology Antwerp University Hospital Edegem Belgium
- Tohoku University (JP)
- Cardiothoracovascular Department Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste Trieste Italy
- Manchester University NHS Foundation Trust (GB)
- Corresponding author
- Merlo, Marco
- Sinagra, Gianfranco
- ORCID
- Gentile, Piero
- Merlo, Marco
- Peretto, Giovanni
- Ammirati, Enrico
- Sala, Simone
- Aquaro, Giovanni Donato
- Imazio, Massimo
- Potena, Luciano
- Campodonico, Jeness
- Foà, Alberto
- Raafs, Anne
- Hazebroek, Mark
- Brambatti, Michela
- Nucifora, Gaetano
- Shrivastava, Sanskriti
- Huang, Florent
- Schmidt, Matthieu
- Muser, Daniele
- Aoki, Tatsuo
- Sugimura, Koichiro
- Shimokawa, Hiroaki
- Artico, Jessica
- Porcari, Aldostefano
- Colopi, Marzia
- Bussani, Rossana
- Barbati, Giulia
- Garascia, Andrea
- Cipriani, Manlio
- Agostoni, Piergiuseppe
- Pereira, Naveen
- Heymans, Stephane
- Adler, Eric D.
- Camici, Paolo Guido
- Frigerio, Maria
- Sinagra, Gianfranco
- Venue
- European Journal of Heart Failure
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-07-21
- Volume
- 23
- Issue
- 12
- Pages
- 2045-2054
- ISSN
- 1388-9842 (ISSN-L)
- 1879-0844
- OpenAlex
- W3176601339
- Cited by
- 46
- References
- 33
- Citations by year
- 2026: 14 · 2025: 10 · 2024: 6 · 2023: 5 · 2022: 8 · 2021: 3
- FWCI
- 3.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Heart Failure (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- HAL (submittedVersion)
- Institutional Research Information System (University of Udine) (submittedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- ArTS Archivio della ricerca di Trieste (University of Trieste https://www.units.it/) (submittedVersion, other-oa)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- Lirias (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Viral Infections and Immunology Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- acute myocarditis, life-threatening ventricular arrhythmias, sustained ventricular tachycardia, sudden cardiac death, ventricular fibrillation, arrhythmia recurrence, risk stratification, cardiac magnetic resonance, late gadolinium enhancement, STIR, implantable cardioverter-defibrillator, post-discharge outcomes
- MeSH terms
- Adult, Aftercare, Contrast Media, Female, Gadolinium, Heart Failure, Humans, Male, Myocarditis, Patient Discharge, Retrospective Studies, Tachycardia, Ventricular, Risk Assessment
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