Research Article| Volume 123, ISSUE 1, P139-144, January 01, 2019

Predictors, Burden, and the Impact of Arrhythmia on Patients Admitted for Acute Myocarditis

Published:September 26, 2018DOI:
      A significant proportion of patients with acute myocarditis experience sudden cardiac death presumably due to cardiac arrhythmia. In this study, we explore the burden, the predictors of arrhythmia in acute myocarditis and the association between arrhythmias and adverse in-hospital outcomes. After evaluating the frequency of various tachyarrhythmias and bradyarrhythmia in myocarditis population, we built a logistic model to determine the independent predictors of arrhythmias in myocarditis and a 1:1 propensity-matched analysis to examine the impact of arrhythmias. Overall, cardiac arrhythmias were identified in 33.71% of the hospitalized myocarditis cases. Ventricular tachycardia and atrial fibrillation were most common arrhythmias. There were increased odds of in-hospital mortality, cardiogenic shock, use of mechanical circulatory support, pacemaker implantation, and nonroutine hospital discharges in the arrhythmia cohorts. Length of stay and cost of hospitalization were also significantly higher. A significant proportion of patients with myocarditis have cardiac arrhythmias. As the occurrence of arrhythmias in myocarditis is associated with worse outcomes, it may be important to risk stratify patient to identify those who will benefit from early intervention.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Baksi A.J.
        • Kanaganayagam G.S.
        • Prasad S.K.
        Arrhythmias in viral myocarditis and pericarditis.
        Cardiac Electrophysiol Clin. 2015; 7: 269-281
        • Fabre A.
        • Sheppard M.N.
        Sudden adult death syndrome and other non-ischaemic causes of sudden cardiac death.
        Heart. 2006; 92: 316
        • Harris K.M.
        • Nwaudo D.
        • Bennett M.
        • Haas T.
        • Maron B.J.
        Under-recognized causes of sudden death in young athletes: myocarditis and mitral valve prolapse.
        J Am Coll Cardiol. 2018; 71: A396
        • Ristić A.D.
        • Maisch B.
        • Hufnagel G.
        • Seferovic P.M.
        • Pankuweit S.
        • Ostojic M.
        • Moll R.
        • Olsen E.
        Arrhythmias in acute pericarditis; an endomyocardial biopsy study.
        Herz. 2000; 25: 729-733
        • Chauveau S.
        • Sanchez I.
        • Chevalier P.
        Persistent abnormal intraventricular conduction after myocarditis revealed by recurrent syncopes.
        J Electrocardiol. 2013; 46: 356-358
        • Drafts B.C.
        • Dubose T.D.
        • Sutton B.J.
        • Thohan V.
        Incessant Ventricular Tachycardia and Cardiogenic Shock: A Common Presentation of an Uncommon Diagnosis.
        Am J Med Sci. 2011; 342: 527-529
        • Huttin O.
        • Frikha Z.
        • Brembilla-Perrot B
        • Sellal J.-M.
        • Mandry D.
        • Aliot E.
        • Juilliere Y.
        • Sadoul N.
        • Selton-Suty C.
        Acute myocarditis presenting with ventricular arrhythmias: the role of CMR in the differential diagnosis of ARVD.
        Intern Med. 2013; 52: 1915-1918
        • Merinopoulos I.
        • Vassiliou V.
        • Porter J.N.
        • Acton S.
        • Braganza D.R.
        An unusual but reversible cause of ventricular fibrillation.
        J R Coll Physicians Edinb. 2013; 43: 119-221
        • Vijayan S.
        • Chase A.
        • Barry J.
        Swine flu myocarditis presenting with life threatening ventricular tachycardia.
        J R Soc Med. 2012; 105: 314-316
        • Mahdi A.
        • Anderson S.
        • Carley S.
        • Mahadevan V.
        Spotting the complex tachycardia.
        Emerg Med J. 2010; 27: 239-241
        • HCUP Overview
        Healthcare Cost and Utilization Project (HCUP). January 2018. Agency for Healthcare Research and Quality, Rockville, MD.
        Agency for Healthcare Research and Quality, Rockville, MD2018 (January) (Accessed on July 2018)
        • Newman W.C.
        • Kubilis P.S.
        • Hoh B.L.
        Validation of a neurovascular comorbidities index for retrospective database analysis.
        J Neurosurg. 2018; : 1-5
        • DeShazo J.P.
        • Hoffman M.A.
        A comparison of a multistate inpatient EHR database to the HCUP Nationwide Inpatient Sample.
        BMC Health Serv Res. 2015; 15: 384
        • Houchens R R.D.
        • Elixhauser A.
        Final report on calculating National Inpatient Sample (NIS) variances for data years 2012 and later December 12015. HCUP Methods Series Report # 2015-09 ONLINE. 4, 2015. U.S. Agency for Healthcare Research and Quality.
        ([Available from) (Accessed on June 2018)
        • Mallikethi-Reddy S.
        • Akintoye E.
        • Trehan N.
        • Sharma S.
        • Briasoulis A.
        • Jagadeesh K.
        • Rubenfire M.
        • Grines C.L
        • Afonso L.
        Burden of arrhythmias in peripartum cardiomyopathy: analysis of 9841 hospitalizations.
        Int J Cardiol. 2017; 235: 114-117
        • HCUP Databases
        Healthcare Cost and Utilization Project (HCUP). February 2018. Agency for Healthcare Research and Quality, Rockville, MD.
        Agency for Healthcare Research and Quality, Rockville, MD2018 (Available from:) (Accessed on June 2018)
      1. Consumer Price Index Data from 1913 to 2018. U.S. Department of Labor Bureau of Labor Statistic. [Available from: (Accessed on May 2018).

        • Austin P.C.
        Propensity-score matching in the cardiovascular surgery literature from 2004 to 2006: A systematic review and suggestions for improvement.
        J Thorac Cardiovasc Surg. 2007; 134 (e3): 1128-1135
        • Khera R
        • Angraal S
        • Couch T
        • Welsh JW
        • Nallamothu BK
        • Girotra S
        • Chan PS
        • Krumholz HM
        Adherence to methodological standards in research using the national inpatient sample.
        JAMA. 2017; 318: 2011-2018
        • Zipes DP
        • Camm AJ
        • Borggrefe Martin
        • Buxton AE
        • Chaitman B
        • Fromer M
        • Gregoratos G
        • Klein G
        • Myerburg RJ
        • Quinones MA
        • Roden DM
        • Silka MJ
        • Tracy C
        • Smith Jr, SC
        • Jacobs AK
        • Adams CD
        • Antman EM
        • Anderson JL
        • Hunt SA
        • Halperin JL
        • Nishimura R
        • Ornato JP
        • Page RL
        • Riegel B
        • Priori SG
        • Moss AJ
        • Priori SG
        • Blanc J-J
        • Budaj A
        • Camm AJ
        • Dean V
        • Deckers JW
        • Despres C
        • Dickstein K
        • Lekakis J
        • McGregor K
        • Metra M
        • Morais J
        • Osterspey A
        • Tamargo JL
        • Zamorano JL
        ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.
        EP Europace. 2006; 8: 746-837
        • Koplan B.A.
        • Stevenson W.G.
        Ventricular tachycardia and sudden cardiac death.
        Mayo Clin Proc. 2009; 84: 289-297
        • Ding Z.
        • Yang M.
        • Wang Y.
        • Wu S.
        • Qiu X.
        • Liu Q.
        Retrospective analysis of 769 cases of sudden cardiac death from 2006 to 2015: a forensic experience in China.
        Forensic Sci Med Pathol. 2017; 13: 336-341
        • Balady G.J.
        Sudden cardiac death in young military recruits: Guarding the heart of a soldier.
        Ann Intern Med. 2004; 141: 882-884
        • Biernacka A.
        • Frangogiannis N.G.
        Aging and cardiac fibrosis.
        Aging Dis. 2011; 2: 158-173
        • Anzini M.
        • Merlo M.
        • Artico J.
        • Sinagra G.
        Arrhythmic risk prediction of acute myocarditis presenting with life-threatening ventricular tachyarrhythmias.
        Int J Cardiol. 2016; 212: 169-170
        • Anakwue R.C.
        • Onwubere B.J.
        • Ikeh V.
        • Anisiuba B.
        • Ike S.
        • Anakwue A.-M.C.
        Echocardiographic assessment of left ventricular function in thyrotoxicosis and implications for the therapeutics of thyrotoxic cardiac disease.
        Ther Clin Risk Manage. 2015; 11: 189-200
        • Anakwue R.C.
        • Onwubere B.J.
        • Ikeh V.
        • Anisiuba B.
        • Ike S.
        • Anakwue A.-M.C.
        Clinical presentation and outcome in a contemporary cohort of patients with acute myocarditis: the multicenter Lombardy registry.
        Circulation. 2018; 138: 1088-1099
        • Goitein O.
        • Matetzky S.
        • Beinart R.
        • Segni E.D.
        • Hod H.
        • Bentancur A.
        • Konen E.
        Acute myocarditis: noninvasive evaluation with cardiac MRI and transthoracic echocardiography.
        Am J Roentgenol. 2009; 192: 254-258
        • Sarrazin M.S.
        • Rosenthal G.E.
        Finding pure and simple truths with administrative data.
        JAMA. 2012; 307: 1433-1435