Prognostic Value of Electrocardiography in Patients With Fulminant Myocarditis Supported by Percutaneous Venoarterial Extracorporeal Membrane Oxygenation　― Analysis From the CHANGE PUMP Study ―

Abstract

on behalf of the CHANGE PUMP InvestigatorsBackground: Fulminant myocarditis (FM) presents various abnormal findings on ECG, the prognostic impact of which has not been not fully elucidated. The aim of this study was therefore to clarify the prognostic value of ECG data in FM patients supported by venoarterial extracorporeal membrane oxygenation (VA-ECMO). Methods and Results:In this multicenter chart review, we investigated 99 patients with FM supported by VA-ECMO. The final cohort consisted of 87 patients (mean age, 52±16 years; female, 42%) after 12 patients who required conversion to other forms of mechanical circulatory support were excluded. The median LVEF was 14.5%. At the time of VA-ECMO initiation, 38 patients (44%) had arrhythmias including atrial fibrillation (6%), complete atrioventricular block (CAVB; 17%), and ventricular tachycardia or fibrillation (VT/VF; 15%). Of the 49 patients with sinus rhythm (SR), 26 had QRS duration ≥120 ms (wide QRS). On logistic regression analysis, wide QRS predicted in-hospital death in patients with SR (OR, 3.6; 95% CI: 1.07-13.61, P=0.04). Compared with SR with narrow QRS (QRS duration <120 ms), CAVB and VT/VF had a higher risk of in-hospital death (CAVB: OR, 7.20; 95% CI: 1.78-34.15, P=0.005; VT/VF: OR, 8.10; 95% CI: 1.86-42.31, P=0.005). Conclusions:In patients with FM, CAVB and VT/VF carried a higher risk of in-hospital death. Wide QRS also predicted a higher risk of in-hospital death in patients with SR.

First case of COVID-19 complicated with fulminant myocarditis: a case report and insights

“…CRRT and ECMO remove some of the cytokines from the blood and increase blood oxygen saturation, reducing the excessive immune response of cytokines in the body and further reducing myocardial damage. Furthermore, a study showed that complete atrioventricular block, ventricular tachycardia, and fibrillation are risk factors for in-hospital death in fulminant myocarditis patients [14]. The absence of such electrocardiogram anomalies in this case may have contributed to the rapid improvement in the patient's heart condition, and the prognosis of this patient may have been better if secondary infection could have been controlled.…”

First Case of COVID-19 Infection with Fulminant Myocarditis Complication: Case Report and Insights

“…Furthermore, a study shows complete atrioventricular block, ventricular tachycardia or fibrillation are risk factors for in-hospital death in fulminant myocarditis patients. Extensive QRS waves also predict poor outcomes in such cases[12]. The absence of such electrocardiogram anomaly in this case may have contributed to the rapid improvement in the patient's heart condition.ConclusionCOVID-19 patients may develop severe cardiac complications such as myocarditis and heart failure, and this is the first case of COVID-19 that is complicated with fulminant myocarditis.…”

Case report of an isolated myocarditis due to COVID-19 infection in a paediatric patient

“… 9 Cytokine storms may lead to increased vascular wall permeability and myocardial oedema. 10 However, in view of the patient’s rapid recovery, low increase of C-reactive protein, and the early presentation of the acute myocarditis, myocardial injury was considered to be transient damage from viral infection rather than from the cytokine storm. In addition, the clinical outcome of the patient was favourable, without use of corticosteroids, antiviral drugs, or chloroquine.…”