Department of Internal Medicine, Englewood Hospital and Medical Center, Seton Hall University-Hackensack Meridian School of Medicine, Englewood, New Jersey.
Department of Medicine, John H Stroger Jr. Hospital of Cook County, Chicago, Illinois.
Am J Cardiol. 2019 Jan 1;123(1):139-144. doi: 10.1016/j.amjcard.2018.09.017. Epub 2018 Sep 27.
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.
相当一部分急性心肌炎患者发生心源性猝死，推测是由于心律失常所致。本研究旨在探讨急性心肌炎患者心律失常的发生率、预测因素及心律失常与住院期间不良结局之间的关系。评估心肌炎患者各种快速性心律失常和缓慢性心律失常的频率后，我们建立了一个逻辑模型来确定心肌炎患者心律失常的独立预测因素，并进行了 1:1 倾向匹配分析以检查心律失常的影响。总体而言，住院心肌炎患者中有 33.71%发生心律失常。室性心动过速和心房颤动是最常见的心律失常。心律失常组患者住院死亡率、心源性休克、使用机械循环支持、植入起搏器和非常规出院的风险更高。住院时间和住院费用也显著增加。相当一部分心肌炎患者存在心律失常。由于心肌炎患者发生心律失常与预后较差相关，因此对患者进行风险分层以识别那些可能受益于早期干预的患者可能很重要。
