Post-discharge arrhythmic risk stratification of patients with acute myocarditis and life-threatening ventricular tachyarrhythmias

Piero Gentile, Marco Merlo, Giovanni Peretto, Enrico Ammirati, Simone Sala, Paolo Della Bella, Giovanni Donato Aquaro, Massimo Imazio, Luciano Potena, Jeness Campodonico, Alberto Foà, Anne Raafs, Mark Hazebroek, Michela Brambatti, Andreja Cerne Cercek, Gaetano Nucifora, Sanskriti Shrivastava, Florent Huang, Matthieu Schmidt, Daniele MuserCaroline M. Van de Heyning, Emeline Van Craenenbroeck, Tatsuo Aoki, Koichiro Sugimura, Hiroaki Shimokawa, Antonio Cannatà, Jessica Artico, Aldostefano Porcari, Marzia Colopi, Andrea Perkan, Rossana Bussani, Giulia Barbati, Andrea Garascia, Manlio Cipriani, Piergiuseppe Agostoni, Naveen Pereira, Stephane Heymans, Eric D. Adler, Paolo Guido Camici, Maria Frigerio, Gianfranco Sinagra

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)2045-2054
Number of pages10
JournalEuropean Journal of Heart Failure
Issue number12
StatePublished - Dec 2021


  • Acute myocarditis
  • Arrhythmic risk stratification
  • Cardiac magnetic resonance
  • Implantable cardioverter-defibrillator
  • Ventricular arrhythmias

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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