Abstract 14843: Electrocardiographic Manifestations of Immune Checkpoint Inhibitor Associated Myocarditis

• Published in: Circulation (New York, N.Y.) N.Y.), 2020-11, Vol.142 (Suppl_3 Suppl 3), p.A14843-A14843
• Main Authors: Power, John R, Alexandre, Joachim, Choudhary, Arrush, ozbay, benay, Palaskas, Nicolas L, Lehmann, Lorenz H, Finke, Daniel, Cautela, Jennifer, Thuny, Franck, Tamura, Yuichi, Hayek, Salim S, Azam, Tariq U, Asnani, Aarti, Mehegan, Tyler, Aras, Mandar A, Baik, Alan H, Gilstrap, Lauren, Laufer-Perl, Michal, Arangalage, Dimitri, Ewer, Steven, Martini, Matthew, Nowatzke, Joseph, Orimoloye, Olusola A, Brinkley, Douglas M, Meijers, Wouter C, Fenioux, Charlotte, EDERHY, Stephane, Moslehi, Javid J, Salem, Joe-elie
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.142.suppl_3.14843

IntroductionImmune checkpoint inhibitor (ICI)-myocarditis is a new syndrome with estimated 50% mortality. Similar to acute cellular rejection (ACR), it is pathologically characterized by lymphocytic infiltration. We aimed to characterize the electrocardiograph features of ICI-myocarditis, compare them to ACR, and evaluate their association with adverse outcome. MethodsPresenting ECG of 130 cases of ICI-myocarditis were collected from a multicenter network spanning 12 countries and compared to 50 cases of ACR. ECG were quantified and interpreted by two blinded cardiologists. 53 patients with ICI-myocarditis had baseline ECG available for comparison via paired univariate analysis. Cox models correcting for age and sex determined association with a composite outcome of life-threatening arrhythmia or myocarditis-related death. ResultsICI-myocarditis patients had average age of 68(58-76), were 61.2% male, and 64.8% had prior cardiovascular disease. QRS prolongation (26% vs 13%, p=0.008), conduction disorders (67% vs 44%, p=0.007) such as left bundle branch block (LBBB) (18% vs 4% p=0.008), ST/T wave changes (50% vs 24%, p=0.004), and PVCs (16% vs 6%, p=0.020) were more prevalent on presenting ECG compared to baseline. ICI-myocarditis showed more PVCs (16% vs 2%, p=0.011) and less ST/T wave changes (41% vs 66%, p=0.002) when compared to ACR. On multivariate analysis, the combined outcome of life-threatening arrhythmia or myocarditis-related death was associated with pathological Q waves (HR=3.60 (1.78-7.27) p