Abstract
Background and Objectives: Disorders of cardiac rhythm commonly manifest in patients with acute myocarditis, particularly during the acute phase. Malignant arrhythmias in acute myocarditis contribute to it emerging as a leading cause of sudden death in previously structurally normal young individuals. Aberrations on the electrocardiogram (ECG) may serve as independent predictors of adverse events in patients with acute myocarditis, such as pathological Q waves, widened QRS complexes, elevated ST segments, hazardous ventricular arrhythmias, and ECG indices. The study aims to delineate these changes and assess the prognostic significance of selected ECG alterations in acute myocarditis.
Methods: We conducted a retrospective electrocardiographic analysis of 119 patients with suspected acute myocarditis treated at Bach Mai Hospital from 2017 to 2021. Electrocardiographic changes were analyzed and incorporated into a regression model to assess their correlation with the occurrence of adverse clinical outcomes during the hospitalization period.
Results: Among 119 patients (66.4% male; mean age 33.93 ± 15.87 years) with suspected acute myocarditis, common electrocardiographic changes included: widened QRS in 20.2%, pathological Q waves in 6.7%, ST elevation in 14.3%, ventricular arrhythmias in 3.4%, and an electrocardiographic index of 248.39 ± 96.66. These changes occurred at a higher rate in the group with complications, although the differences were not statistically significant. In terms of prognostic significance, widened QRS had predictive value for left ventricular dysfunction and in-hospital mortality; pathological Q waves were associated with a higher risk of in-hospital mortality; ventricular arrhythmias and the electrocardiographic index were prognostic indicators for the development of cardiac shock in patients with acute myocarditis.
Conclusions: The electrocardiographic changes, including widened QRS, pathological Q waves, ventricular arrhythmias, and the ECG index, hold prognostic significance in patients with suspected acute myocarditis.