Usefulness of Electrocardiographic Markers to Predict Ventricular Arrhythmias in Acute Myocarditis Patients

Abstract

Aims: Acute myocarditis is an inflammatory disease of the myocardium and is characterized by a large heterogeneity of clinical presentation. Myocarditis is becoming to be recognized as a contributor to unexplained mortality, and is thought to be a major cause of sudden cardiac death in the first two decades of life. Myocardial inflammation, ion channel dysfunction, electrophysiological and structural remodelling may play important roles in life-threatening arrhythmias. We aimed to investigate the ventricular arrhythmia predictors in myocarditis patients by using electrocardiographic markers. Methods: A total of 56 patients (mean age 22.5 ± 3.7 years; 89% males) with acute myocarditis were enrolled in the study. Tpeak-Tend intervals, Tpeak-Tend/QT and Tpeak-Tend/corrected QT (QTc), cardio-electrophysiological balance (QT/QRS) and heart rate-corrected QT(QTc)/QRS ratios were calculated from 12-lead electrocardiogram. Results: Heart rate, QT and QTc values were similar between groups. QRS complexes were lower in arrhythmia positive group than arrhythmia negative group (p=0.004). Tpeak-Tend intervals, Tpeak-Tend/QT, Tpeak-Tend/ QTc, cardio-electrophysiological balance and heart rate-corrected QT(QTc)/QRS values were significantly higher in arrhythmia positive group (< 0.001, < 0.001, p=0.03, p=0.04 and < 0.001, respectively). Conclusion: In this study, we observed that higher Tpeak-Tend, Tpeak-Tend/QT, Tpeak-Tend/QTc , cardio-electrophysiological balance (ICEB) and heart rate-corrected QT(QTc)/QRS ratio are associated with ventricular arrhythmic episodes in acute myocarditis patients. These electrocardiographic markers may be beneficial to identify high risk patients for arrhytmias complicating myocarditis.

Evaluation of index of cardiac electrophysiological balance in COVID-19 patients

“…Yumurtaci et al evaluated iCEB as an indicator of ventricular arrhythmia in patients with acute myocarditis. The authors reported that iCEB values were signifi cantly higher in the arrhythmia group compared to the non-arrhythmia group (17).…”

“…Studies in different patient populations reported that iCEB indicates the susceptibility to developing malignant ventricular arrhythmia (15)(16)(17). Sivri et al assessed iCEB before and after hemodialysis in 52 patients with end-stage renal disease (ESRD).…”

Evaluation of index of cardio-electrophysiological balance and Tp-e/QT ratio in patients with coronary artery ectasia

“…Based on these findings, Yumurtacı O et al [16] found that iCEB and heart rate-corrected QT(QTc)/QRS ratio was higher in patients with acute myocarditis who had ventricular arrhythmic episodes compare to uneventful control group. Recently, Ucar FM et al [17] have investigated the balance of ventricular depolarization and repolarization in patients with rheumatoid arthritis by using iCEB.…”

Prognostic implications of the electrocardiographic findings in acute myocarditis: Which is the strongest one?

“…ECG findings of acute myocarditis may appear as changes in the ST segment or T wave and/or as a pathologic Q wave that may be confused with acute myocardial infarction. 11 , 12 , 13 These findings may be the result of diffuse myocardial inflammation which are associated with conduction abnormalities. However, our study showed that the specific ECG findings in fulminant myocarditis are related to QRS duration rather than ST segment changes.…”