Arrhythmic Burden After Myocarditis: From Molecular Mechanisms to Therapeutic Strategies

Myocarditis is an underdiagnosed inflammatory condition of the myocardium that may lead to significant complications, including life-threatening ventricular arrhythmias and sudden cardiac death, particularly in young individuals. The arrhythmogenic substrate evolves dynamically across the disease course, driven by acute inflammation, ion channel alterations, immune-mediated cytotoxicity and negative structural remodelling. Persistent myocardial inflammation and fibrosis promote conduction abnormalities, triggered activity and re-entrant circuits, creating a proarrhythmic milieu. Despite increasing recognition of its clinical relevance, arrhythmias management in myocarditis remains challenging due to the variability in patient presentation and disease trajectory. This review examines arrhythmogenic mechanisms associated with myocarditis, exploring differential contribution of the above-reported triggers to concurrent electrical instability. Updated therapeutic approaches to managing arrhythmias in myocarditis are discussed, with emphasis on the importance of individualised treatment plans. A deeper understanding of the complex interplay between inflammation and arrhythmias may improve clinical decision-making, and help tailor individualised management strategies for affected patients.