Cardiac Arrhythmias in Patients with Myocarditis in the Post-COVID-19 Period

To date, several cardiotropic viruses have been implicated as causes of myocarditis. The most detected are parvovirus B19, and human herpes virus 6. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) are the respiratory viruses that have recently triggered the unprecedented pandemic process. The involvement and impact of these viruses in viral cardiovascular disease are under study. Despite extensive research into the pathological mechanisms of viral infections of the cardiovascular system, our knowledge regarding their treatment and management is still incomplete. A condition caused by post- Co rona Virus Disease (COVID-19) myocarditis seems to have distinct inflammatory characteristics. Many kinds of arrhythmias may occur in patients with post-COVID-19 myocarditis and result in arrhythmogenic cardio-myopathy and sudden cardiac death. Sometimes arrhythmia can be the first and only symptom of myocarditis. However, compared to the other clinical presentations, arrhythmic myocarditis has been poorly described in the literature. The increased risk of arrhythmias in patients with a post-COVID-19 period is most likely a consequence of systemic inflammation and diseases, not just a direct consequence of the viral infection. A decrease in heart rate variability can contribute to electrical instability of the myocardium and the occurrence of arrhythmias. Cardiac magnetic resonance imaging and endomyocardial biopsy are the most useful tests for myocarditis. However, different from the other clinical presentations, arrhythmic myocarditis requires specific diagnostic, prognostic, and therapeutic considerations. This review aims to critically summarize the state of the art on myocarditis presenting with arrhythmias in terms of epidemiology, aetiology, diagnosis, prognosis, and treatment. Keywords: Post-COVID-19; SARS-CoV-2; Myocarditis; Arrhythmias; Ferroptosis; Vaccination