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Myocarditis in the Athlete: Arrhythmogenic Substrates, Clinical Manifestations, Management, and Eligibility Decisions

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Abstract

Myocarditis is as an important cause of sudden cardiac death (SCD) among athletes. The incidence of SCD ascribed to myocarditis did not change after the introduction of pre-participation screening in Italy, due to the transient nature of the disease and problems in the differential diagnosis with the athlete’s heart. The arrhythmic burden and the underlying mechanisms differ between the acute and chronic setting, depending on the relative impact of acute inflammation versus post-inflammatory myocardial fibrosis. In the acute phase, ventricular arrhythmias vary from isolated ventricular ectopic beats to complex tachycardias that can lead to SCD. Atrioventricular blocks are typical of specific forms of myocarditis, and supraventricular arrhythmias may be observed in case of atrial inflammation. Athletes with acute myocarditis should be temporarily restricted from physical exercise, until complete recovery. However, ventricular tachycardia may also occur in the chronic phase in the context of post-inflammatory myocardial scar.

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Abbreviations

AM:

Acute myocarditis

SCD:

Sudden cardiac death

EMB:

Endomyocardial biopsy

LGE:

Late gadolinium enhancement

CMR:

Cardiac magnetic resonance

AV:

Atrioventricular

LV:

Left ventricular

AF:

Atrial fibrillation

VF:

Ventricular fibrillation

VT:

Ventricular tachycardia

ICD:

Implantable cardioverter defibrillator

ARVC:

Arrhythmogenic right ventricular cardiomyopathy

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Authors and Affiliations

  1. Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy

    Riccardo Vio, Alessandro Zorzi & Domenico Corrado

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  1. Riccardo Vio
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  2. Alessandro Zorzi
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  3. Domenico Corrado
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Correspondence to Domenico Corrado.

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Vio, R., Zorzi, A. & Corrado, D. Myocarditis in the Athlete: Arrhythmogenic Substrates, Clinical Manifestations, Management, and Eligibility Decisions. J. of Cardiovasc. Trans. Res. 13, 284–295 (2020). https://doi.org/10.1007/s12265-020-09996-1

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