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Abstract
<p class="first" id="d8334811e83">Myocarditis is a major cause of sudden cardiac death
(SCD) and dilated cardiomyopathy
(DCM) in young adults. Cardiac magnetic resonance is the established tool for the
diagnosis of myocarditis, and late gadolinium enhancement detected on cardiac magnetic
resonance imaging is the strongest independent predictor of SCD, all-cause mortality,
and cardiac mortality. Several other factors have been associated with SCD or cardiac
transplantation including New York Heart Association functional class III/IV, reduced
left ventricular ejection fraction <35%, and right ventricular ejection fraction
≤45%.
A fragmented QRS and a prolonged QTc interval on an electrocardiogram are predictors
of VAs. The postulated mechanism of VA in acute myocarditis is ion channel dysfunction
and inflammation that alter intracellular signaling, producing interstitial edema
and fibrosis and thereby causing conduction abnormalities. VAs in chronic myocarditis
are generally due to scar-mediated reentry. Treatment of myocarditis is tailored toward
supportive care and symptomatic relief. The subset of patients who develop DCM should
be treated with heart failure medications according to professional guideline recommendations.
Indications for an implantable cardioverter-defibrillator are similar to those for
nonischemic cardiomyopathy; however, an implantable cardioverter-defibrillator should
be held in the acute phase of myocarditis to allow left ventricular ejection fraction
recovery, and a wearable cardioverter-defibrillator may be beneficial for some patients.
Antiarrhythmic medications are reserved for patients with symptomatic nonsustained
or sustained VAs. Radiofrequency ablation appears to be an effective treatment option
for VAs; however, more data on its safety and effectiveness are needed. This review
addresses risk factors of SCD and VAs in patients with myocarditis with special emphasis
on treatment and prevention of these outcomes.
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