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Publications

Journal Article Ahead of print 1 citation

PubMed: 42663246 DOI: 10.1093/ejhf/xuag271

Workup and management of rhythm disorders in myocarditis and inflammatory cardiomyopathy: a clinical consensus statement of the European Heart Rhythm Association and the Heart Failure Association of the ESC, the ESC Working Group on Myocardial & Pericardial Diseases, the European Association of Preventive Cardiology of the ESC, the Heart Rhythm Society, the Asian Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society.

Eur J Heart Fail

Authors: Giovanni Peretto, Cristina Basso, Antonio Berruezo, Entela Bollano, Alida Linda Patrizia Caforio, Michela Casella, Christian De Chillou, Micaela Ebert, Sabiha Gati, Massimo Imazio, Koshiro Kanaoka, Petr Kuchynka, Enrique Asensio-Lafuente, Jose Luis Merino, Alexander Álvarez Ortiz, Antonis Pantazis, Jayasree Pillarisetti, Giuseppe Rosano, Petar M Seferović, Jacob Tfelt-Hansen, Roderick Tung, Katja Zeppenfeld, Carsten Tschöpe

Affiliations

  • Multidisciplinary Disease Unit for Myocarditis and Arrhythmogenic Cardiomyopathies, Cardiac Electrophysiology Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
  • Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy.
  • Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padova, Italy.
  • Cardiovascular Pathology, Azienda Ospedaliera di Padova, Padova, Italy.
  • Teknon Medical Center, University of Barcelona, Barcelona, Spain.
  • Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
  • Cardiology, Department of Cardiac Thoracic Vascular Science and Public Health, Azienda Ospedale University of Padua, member of ERN-Guard Heart, Padova, Italy.
  • Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Ancona, Italy.
  • Department of Cardiology, University Hospital of Nancy, Nancy, France.
  • Heart Center Dresden, Technische Universität Dresden, Dresden, Germany.
  • Department of Cardiovascular Medicine, Royal Brompton Hospital, London, United Kingdom.
  • Department of Medicine, University of Udine, Udine, Italy.
  • Cardiothoracic Department, University Hospital Santa Maria Della Misericordia, Udine, Italy.
  • Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
  • 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
  • Cardiology Department, Hospital Médica TEC 100, Querétaro, Mexico.
  • Arrhythmia and Robotic Electrophysiology Unit, La Paz University Hospital, IdiPaz, Madrid, Spain.
  • Cardiology Unit, Bucaramanga Heart Institute, Bucaramanga, Colombia.
  • Cardiology Clinic of San Antonio, Methodist Hospital, San Antonio, USA.
  • Department of Human Sciences and Promotion of Quality of Life, San Raffaele Open University of Rome, Rome, Italy.
  • Cardiology Unit, IRCCS San Raffaele, Roma, Italy.
  • Department of Cardiology, Belgrade University Medical Centre, Belgrade, Serbia.
  • The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
  • Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
  • Division of Cardiology, The University of Arizona College of Medicine, Phoenix, AZ, USA.
  • Department of Cardiology, Leiden University, Leiden, The Netherlands.
  • Deutsches Herzzentrum der Charité (DHZC), Klinik für Kardiologie, Angiologie und Intensivmedizin, Augustenburger Platz 1, Berlin 13353, Germany.
  • Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany.
  • DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
  • Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany.

Abstract

Myocarditis is an important and frequently underrecognized cause of atrioventricular conduction disease and ventricular arrhythmias and may also be associated with atrial arrhythmias and sinus node dysfunction. Arrhythmic risk evolves over time as a result of the interplay between myocardial inflammation, fibrosis, and genetic predisposition. Despite its clinical relevance, guidance for the diagnosis, treatment, and follow-up of arrhythmias in myocarditis has remained limited. This consensus statement provides a structured framework for the management of arrhythmias in myocarditis and inflammatory cardiomyopathy (Infl-CMP), integrating disease phase and genetic background into clinical decision-making. It offers practical guidance across the disease spectrum, including diagnostic evaluation, therapeutic strategies, and longitudinal follow-up. The document was jointly developed by the European Heart Rhythm Association of the European Society of Cardiology (ESC) in collaboration with the Heart Failure Association of the ESC, the ESC Working Group on Myocardial & Pericardial Diseases, and the European Association of Preventive Cardiology of the ESC, together with the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society. Consensus advice is organized using a phase-aware framework distinguishing hot, hot-to-cold, and cold phases, with clinical consensus statements graded according to opinion-, observational-, or randomized trial-based evidence and supported by formal author voting. Arrhythmia management is stratified by disease phase. During active inflammation, antiarrhythmic therapy is combined with aetiology-targeted treatment or immunosuppression when indicated. In later stages, substrate-based strategies include pharmacological therapy, device implantation, or ablation. Emphasis is placed on hot-to-cold transition as an arrhythmogenic window and on risk stratification.

MeSH

Heart Failure, Heart, Arrhythmias, Cardiac, Cold Temperature, Cardiology, Myocarditis, Therapeutics, Cardiomyopathies