Sudden cardiac death risk in contact sports increased by myocarditis: a case series

Abstract Background Myocarditis is a known cause of sudden cardiac death of the athlete. The impact of direct chest trauma in at-risk sports or activities in patients with a history of myocarditis has never been demonstrated or studied. We report herein two cases of life-threatening ventricular arrhythmia secondary to non-penetrating blunt chest trauma while playing contact sports. Case summary The first patient, a 26-year-old man described a brief loss of consciousness after having received blunt impact to the chest (typical intensity) while playing a rugby match. The loss of consciousness was total and proceeded by rapid and regular palpitations. He had a history of viral myocarditis 10 years prior with a fibrotic sequalae in the inferolateral wall on cardiac magnetic resonance imaging (left ventricular ejection fraction 71%). Right apical ventricular pacing induced a sustained monomorphic ventricular tachycardia reproducing the patient’s symptoms. A subcutaneous implantable cardioverter-defibrillator was implanted. The second patient is a 22-year-old professional rugby player with no known notable history. During a match, a direct blow to the chest wall was followed by a cardiac arrest. A ventricular fibrillation was cardioverted to pulseless electrical activity. Patient died despite cardiopulmonary resuscitation. An autopsy identified a myocardial sequela of fibrosis with no acute inflammatory remodelling compatible with a previous myocarditis. Discussion Myocarditis may increase the risk of life-threatening ventricular arrhythmias caused by blunt impact to the chest, particularly in contact sports. Screening and prevention measures should be considered to reduce this risk.

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Impact of Myocardial Bridge on Life‐Threatening Ventricular Arrhythmia in Patients With Implantable Cardioverter Defibrillator

Journal of the American Heart Association ◽

10.1161/jaha.120.017455 ◽

2020 ◽

Vol 9 (21) ◽

Author(s):

Kozo Okada ◽

Kiyoshi Hibi ◽

Yutaka Ogino ◽

Nobuhiko Maejima ◽

Shinnosuke Kikuchi ◽

...

Keyword(s):

Sudden Cardiac Death ◽

Ventricular Arrhythmia ◽

Implantable Cardioverter Defibrillator ◽

Cardiac Death ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Myocardial Bridge ◽

Cardioverter Defibrillator ◽

Life Threatening

Background Myocardial bridge (MB), common anatomic variant, is generally considered benign, while previous studies have shown associations between MB and various cardiovascular pathologies. This study aimed to investigate for the first time possible impact of MB on long‐term outcomes in patients with implantable cardioverter defibrillator, focusing on life‐threatening ventricular arrhythmia (LTVA). Methods and Results This retrospective analysis included 140 patients with implantable cardioverter defibrillator implantation for primary (n=23) or secondary (n=117) prevention of sudden cardiac death. Angiographically apparent MB was identified on coronary angiography as systolic milking appearance with significant arterial compression. The primary end point was the first episode(s) of LTVA defined as appropriate implantable cardioverter defibrillator treatments (antitachyarrhythmia pacing and/or shock) or sudden cardiac death, assessed for a median of 4.5 (2.2–7.1) years. During the follow‐up period, LTVA occurred in 37.9% of patients. Angiographically apparent MB was present in 22.1% of patients; this group showed younger age, lower rates of coronary risk factors and ischemic cardiomyopathy, higher prevalence of vasospastic angina and greater left ventricular ejection fraction compared with those without. Despite its lower risk profiles above, Kaplan–Meier analysis revealed significantly lower event‐free rates in patients with versus without angiographically apparent MB. In multivariate analysis, presence of angiographically apparent MB was independently associated with LTVA (hazard ratio, 4.24; 95% CI, 2.39–7.55; P <0.0001). Conclusions Angiographically apparent MB was the independent determinant of LTVA in patients with implantable cardioverter defibrillator. Although further studies will need to confirm our findings, assessment of MB appears to enhance identification of high‐risk patients who may benefit from closer follow‐up and targeted therapies.

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Unique clinical features and long term follow up of survivors of sudden cardiac death in an Asian multicenter study

Scientific Reports ◽

10.1038/s41598-021-95975-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Pang-Shuo Huang ◽

Jen-Fang Cheng ◽

Wen-Chin Ko ◽

Shu-Hsuan Chang ◽

Tin-Tse Lin ◽

...

Keyword(s):

Sudden Cardiac Death ◽

Cardiac Death ◽

Left Ventricular ◽

Asia Pacific ◽

Left Ventricular Ejection ◽

Arrhythmic Death ◽

Long Term Follow Up ◽

History Of

AbstractThere has been no long-term clinical follow-up data of survivors or victims of sudden cardiac death (SCD). The Taiwan multi-center sudden arrhythmia death syndrome follow-up and clinical study (TFS-SADS) is a collaborative multi-center study with median follow-up time 43 months. In this cohort, the clinical characteristics of these SADS patients were compared with those with ischemic heart disease (IHD). In this SCD cohort, around half (42%) were patients with IHD, which was different from Caucasian SCD cohorts. Among those with normal heart, most had Brugada syndrome (BrS). Compared to those with SADS, patients with IHD were older, more males and more comorbidities, more arrhythmic death, and lower left ventricular ejection fraction. In the long-term follow-up, patients with SADS had a better survival than those with IHD (p < 0.001). In the Cox regression analysis to identify the independent predictors of mortality, older age, lower LVEF, prior myocardial infarction and history of out-of-hospital cardiac arrest were associated with higher mortality and beta blocker use and idiopathic ventricular fibrillation or tachycardia (IVF/IVT) with a better survival during follow-up. History of prior MI was associated with more arrhythmic death. Several distinct features of SCD were found in the Asia–Pacific region, such as higher proportion of SADS, poorer prognosis of LQTS and better prognosis of IVF/IVT. Patients with SADS had a better survival than those with IHD. For those with SADS, patients with channelopathy had a better survival than those with cardiomyopathy.

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Case reports of a c.475G>T, p.E159* lamin A/C mutation with a family history of conduction disorder, dilated cardiomyopathy and sudden cardiac death

BMC Cardiovascular Disorders ◽

10.1186/s12872-019-01282-6 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Tetsuro Yokokawa ◽

Shohei Ichimura ◽

Naoko Hijioka ◽

Takashi Kaneshiro ◽

Akiomi Yoshihisa ◽

...

Keyword(s):

Family History ◽

Sudden Cardiac Death ◽

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Cardiac Death ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

History Of ◽

Conduction Disorder

Abstract Background Patients with some mutations in the lamin A/C (LMNA) gene are characterized by the presence of dilated cardiomyopathy (DCM), conduction abnormalities, ventricular tachyarrhythmias (VT), and sudden cardiac death (SCD). Various clinical features have been observed among patients who have the same LMNA mutation. Here, we show a family with cardiac laminopathy with a c.475G > T, p.E159* LMNA mutation, and a family history of conduction disorder, DCM, VT, and SCD. Case presentation A proband (female) with atrial fibrillation and bradycardia was implanted with a pacemaker in her fifties. Twenty years later, she experienced a loss of consciousness due to polymorphic VT. She had a serious family history; her mother and elder sister died suddenly in their fifties and sixties, respectively, and her nephew and son were diagnosed as having DCM. Genetic screening of the proband, her son, and nephew identified a nonsense mutation (c.475G > T, p.E159*) in the LMNA gene. Although the proband’s left ventricular ejection fraction remained relatively preserved, her son and nephew’s left ventricular ejection fraction were reduced, resulting in cardiac resynchronization therapy by implantation of a defibrillator. Conclusions In this family with cardiac laminopathy with a c.475G > T, p.E159* LMNA mutation, DCM, SCD, and malignant VT occurred. Clinical manifestation of various atrial and ventricular arrhythmias and heart failure with reduced ejection fraction occurred in an age-dependent manner in all family members who had the nonsense mutation. It appears highly likely that the E159* LMNA mutation is related to various cardiac problems in the family of the current report.

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Beyond ejection fraction: Novel clinical approaches towards sudden cardiac death risk stratification in patients with dilated cardiomyopathy

Current Cardiology Reviews ◽

10.2174/1573403x17666210804125939 ◽

2021 ◽

Vol 17 ◽

Author(s):

Issa Pour-Ghaz ◽

Mark Heckle ◽

Ikechukwu Ifedili ◽

Sharif Kayali ◽

Christopher Nance ◽

...

Keyword(s):

Sudden Cardiac Death ◽

Ejection Fraction ◽

Risk Stratification ◽

Cardiac Death ◽

Ventricular Tachyarrhythmia ◽

Total Mortality ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Icd Therapy

: Implantable cardioverter-defibrillator (ICD) therapy is indicated for patients at risk for sudden cardiac death due to ventricular tachyarrhythmia. The most commonly used risk stratification algorithms use left ventricular ejection fraction (LVEF) to determine which patients qualify for ICD therapy, even though LVEF is a better marker of total mortality than ventricular tachyarrhythmias mortality. This review evaluates imaging tools and novel biomarkers proposed for better risk stratifying arrhythmic substrate, thereby identifying optimal ICD therapy candidates.

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New techniques for risk assessment in sudden cardiac death

ESC CardioMed ◽

10.1093/med/9780198784906.003.0550 ◽

2018 ◽

pp. 2327-2330

Author(s):

Juan Fernandez-Armenta ◽

Antonio Berruezo ◽

Juan Acosta ◽

Diego Penela

Keyword(s):

Risk Assessment ◽

Sudden Cardiac Death ◽

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Cardiac Death ◽

Left Ventricular ◽

Ventricular Ejection ◽

Left Ventricular Ejection ◽

Individual Risk ◽

Ventricular Ejection Fraction

Risk stratification for sudden cardiac death (SCD) is one of the main objectives of clinical arrhythmology. Despite increased knowledge of the fundamental basis and predictors of SCD, the estimation of individual risk remains challenging. To date, symptomatic heart failure and reduced left ventricular ejection fraction are the main variables used to identify patients at high risk of SCD who could potentially benefit from preventive therapies. Beyond left ventricular ejection fraction, new diagnostic tools have been proposed to better stratify patients at risk of SCD. Among them, cardiovascular magnetic resonance imaging, which allows direct visualization of the arrhythmogenic substrate, is considered particularly promising. Genetic testing and serum biomarkers may also have a role in SCD risk assessment.

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