Incidence and predictors of major arrhythmic events after acute myocarditis complicated by ventricular arrhythmias: A systematic review and meta-analysis.
Soundous M'Rabet, Elisé G Kaboré, Moshe Rav-Acha et al.
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In 30 seconds
This systematic review and meta-analysis examined recurrence of major arrhythmic events after acute myocarditis complicated by sustained ventricular tachycardia or ventricular fibrillation. Eight observational studies including 355 patients were analyzed, with a mean pooled follow-up of 3.8 years (95% confidence interval, 2.7-5.1). Major arrhythmic events occurred in 46.4% (95% confidence interval, 38.1-54.9; I² = 50.0). The assessed demographic, clinical, imaging, and pre-discharge ICD factors did not consistently predict recurrence.
Key findings
- Major arrhythmic events occurred in 46.4% of patients (95% confidence interval, 38.1-54.9; I² = 50.0).
- Mean pooled follow-up was 3.8 years (95% confidence interval, 2.7-5.1).
- Age, sex, comorbidities, cardiovascular risk factors, and ICD implantation before discharge were not associated with follow-up events.
- Reduced left ventricular ejection fraction and the presence or localization of late gadolinium enhancement were not predictive.
Why it matters
The substantial recurrence rate indicates that patients with sustained ventricular arrhythmias during acute myocarditis may remain at meaningful arrhythmic risk after discharge. The absence of consistent predictors among the factors assessed highlights uncertainty in post-discharge risk stratification and the need for better evidence to inform assessment.
What to keep in mind
The evidence came from eight observational studies, and the authors call for larger multicenter cohorts with standardized criteria. The pooled estimate showed moderate heterogeneity (I² = 50.0).