Severe COVID-19 induced myocarditis in a 35-year-old female resulted in recurrent ventricular fibrillation and cardiac arrest, which was successfully managed with ECMO and ICD placement.
Case Report (n=1)
Severe COVID-19 induced myocarditis can present with recurrent ventricular fibrillation and cardiac arrest in young patients with minimal comorbidities, requiring aggressive supportive care and device therapy.
Abstract Introduction Myocarditis is the inflammation of the myocardium, commonly following viral infections. COVID-19 infection has been associated with myocarditis through mechanisms involving direct viral injury and immune-mediated inflammation. We present a case of severe COVID-19 induced myocarditis resulting in recurrent ventricular fibrillation and cardiac arrest. Case Presentation A 35-year-old female with hypertension presented after a ventricular fibrillation (VF) cardiac arrest. According to her family, she had been experiencing heartburn, cough, and cold symptoms for one week. In the emergency department, she was tachycardic and exhibited rhythmic vocalizations with flailing limb movements, without any personal or family history of seizures. CT head suggested possible hypoxic-ischemic encephalopathy, while CT angiogram of the chest was negative for pulmonary embolism. Laboratory results showed WBC 17.8 ×109/L, potassium 3.3 mmol/L, lactic acid 9.6 mmol/L, and troponin 0.049 ng/mL. Urine studies and drug screen were negative. COVID-19 PCR was positive, and the patient was unvaccinated. During hospitalization, she developed recurrent VF episodes triggered by premature ventricular complexes (PVCs), suspected to be secondary to COVID-19 induced myocarditis. Baseline QTc was mildly prolonged, and further myocardial injury likely impaired potassium channels, causing early afterdepolarizations manifesting as PVCs. She was treated with IV lidocaine to suppress PVCs and later transitioned to beta-blockers. Electrolytes were optimized (potassium 4-5 mmol/L, magnesium 2-2.5 mg/dL), and QT-prolonging medications were avoided. Transthoracic echocardiogram was normal. Coronary angiography revealed normal left ventricular systolic function, end-diastolic pressure, and no significant coronary artery disease. She required transcutaneous pacing followed by a transvenous pacemaker. The patient was transferred to a tertiary care center for veno-venous ECMO and was eventually discharged with a dual-chamber ICD. Discussion Myocarditis can disrupt myocardial conduction and contractility, leading to arrhythmias and heart failure. Symptoms range from mild chest pain and fatigue to severe cardiac arrest. COVID-19 related myocarditis has emerged as a significant post-viral complication, with proposed mechanisms including direct myocardial infection, molecular mimicry, and dysregulated immune response. Management is primarily supportive, focusing on arrhythmia control, hemodynamic stabilization, and inflammation reduction. This case highlights severe COVID-19 induced myocarditis in a young patient with minimal comorbidities, leading to recurrent VF and cardiac arrest. Clinicians should maintain a high index of suspicion for myocarditis in COVID-19 patients presenting with arrhythmias to ensure timely diagnosis and targeted management. This abstract is funded by: None
Prasad et al. (2026) conducted a case report in COVID-19 induced myocarditis (n=1). IV lidocaine, pacing, ECMO, and ICD placement was evaluated. Severe COVID-19 induced myocarditis in a 35-year-old female resulted in recurrent ventricular fibrillation and cardiac arrest, which was successfully managed with ECMO and ICD placement.