Krempke Melina, Büchel Jasmin, Bulatova Kseniya, Balestra Gianmarco M, Haaf Philip, Pouly Jeanne, Drews Paul, Mueller Christian, Knecht Sven, Badertscher Patrick, Mahfoud Felix, Kühne Michael, Sticherling Christian, Krisai Philipp
Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.
Int J Cardiol Heart Vasc. 2025 Jun 19;59:101718. doi: 10.1016/j.ijcha.2025.101718. eCollection 2025 Aug.
Patients with acute myocarditis (AM) often undergo prolonged rhythm monitoring due to the risk for life-threatening arrhythmia.
To describe the occurrence, timing and potential early rule-out of life-threatening arrhythmia in patients with AM.
We included consecutive patients with suspected AM admitted to the ICU/IMC for continuous rhythm monitoring into a cohort study. We assessed the incidence and timing of life-threatening arrhythmia (sustained ventricular tachycardia, ventricular fibrillation, cardiac arrest). To rule-out arrhythmia, we evaluated left ventricular ejection fraction (LVEF), maximal cardiac troponin-T (cTnT) levels and a multivariable model.
Among 304 patients with AM (41 ± 16.6 years, 27 % female), 13 life-threatening arrhythmias occurred in 10 (3.3 %) patients. Of these, 8 occurred within 24 h, 2 between 24-48 h and 3 after 72 h of hospitalization. Patients with life-threatening arrhythmia had substantially higher mortality rates (40 % vs. 0.3 %, p < 0.001). There was no binary cut-off for LVEF and cTnT to rule-out arrhythmia. The last life-threatening arrhythmia occurred before the cTnT-peak in 3 (42.9 %), simultaneously with the peak in 1 (14.3 %), and after the peak in 3 (42.9 %) patients. The final multivariable model included female sex, cTnT, and LVEF and demonstrated an area under the curve of 0.98 (95 % CI 0.96-1), with a sensitivity of 99 % and specificity of 75 % to rule-out life-threatening arrhythmia.
In patients with suspected AM, life-threatening arrhythmias were rare but associated with a 40% mortality rate. A combined model including 3 clinical variables ruled-out life-threatening arrhythmia with a high sensitivity and may help to guide the indication of rhythm monitoring.
急性心肌炎（AM）患者由于存在危及生命的心律失常风险，常需进行长时间的心律监测。
描述AM患者中危及生命的心律失常的发生情况、发生时间以及潜在的早期排除方法。
我们将因持续心律监测而入住重症监护病房/中间监护病房的疑似AM连续患者纳入一项队列研究。我们评估了危及生命的心律失常（持续性室性心动过速、心室颤动、心脏骤停）的发生率和发生时间。为了排除心律失常，我们评估了左心室射血分数（LVEF）、心肌肌钙蛋白T（cTnT）最高水平以及一个多变量模型。
在304例AM患者（41±16.6岁，27%为女性）中，10例（3.3%）患者发生了13次危及生命的心律失常。其中，8次发生在24小时内，2次发生在24至48小时之间，3次发生在住院72小时后。发生危及生命的心律失常的患者死亡率显著更高（40%对0.3%，p<0.001）。LVEF和cTnT没有用于排除心律失常的二元临界值。最后一次危及生命的心律失常在3例（42.9%）患者中发生在cTnT峰值之前，1例（14.3%）与峰值同时发生，3例（42.9%）在峰值之后发生。最终的多变量模型包括女性性别、cTnT和LVEF，其曲线下面积为0.98（95%CI 0.96 - 1），排除危及生命的心律失常的敏感性为99%，特异性为75%。
在疑似AM患者中，危及生命的心律失常很少见，但死亡率为40%。一个包含3个临床变量的联合模型以高敏感性排除了危及生命的心律失常，可能有助于指导心律监测的指征。
