Key result
In patients with fulminant myocarditis on VA-ECMO, ventricular tachycardia/fibrillation (OR 8.10) and complete atrioventricular block (OR 7.20) were associated with a significantly higher risk of in-hospital death.
Why the study?
Do specific ECG abnormalities (wide QRS, CAVB, VT/VF) predict in-hospital death in patients with fulminant myocarditis supported by VA-ECMO?
Cohort (n=87)
Yes
Do specific ECG abnormalities (wide QRS, CAVB, VT/VF) predict in-hospital death in patients with fulminant myocarditis supported by VA-ECMO?
Odds Ratio: 8.1 (95% CI 1.86–42.31)
p-value: p=0.005
In patients with fulminant myocarditis on VA-ECMO, baseline ECG findings of complete AV block, VT/VF, and wide QRS are strong predictors of in-hospital mortality and can aid in early risk stratification.
May aid risk stratification in VA-ECMO-supported fulminant myocarditis; hypothesis-generating and requires prospective validation before guiding decisions.
BACKGROUND: 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.
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Sawamura et al. (2018) conducted a cohort in Fulminant myocarditis supported by venoarterial extracorporeal membrane oxygenation (VA-ECMO) (n=87). Ventricular tachycardia or fibrillation (VT/VF) vs. Sinus rhythm with narrow QRS was evaluated on In-hospital death (OR 8.10, 95% CI 1.86-42.31, p=0.005). In patients with fulminant myocarditis on VA-ECMO, ventricular tachycardia/fibrillation (OR 8.10) and complete atrioventricular block (OR 7.20) were associated with a significantly higher risk of in-hospital death.