Recurrent ventricular tachycardia in a patient with COVID-19 vaccine-associated myocarditis: a case report

The development of coronavirus disease 2019 (COVID-19) vaccine-associated myocarditis has been reported. Most of the reported cases are mild, with quick clinical recovery and excellent short-term outcomes. Cases of COVID-19 vaccine-associated myocarditis presenting with sustained ventricular tachycardia (VT) are rare.

A 46-year-old male patient with no prior cardiac history presented following two episodes of syncope. Two days earlier, he had received his second dose of COVID-19 mRNA vaccine (Pfizer)-first dose was administered three weeks earlier. He had an episode of VT while in the emergency room. His cardiac magnetic resonance imaging (MRI) findings were consistent with myocarditis. He was eventually diagnosed with COVID-19 vaccine-associated myocarditis after all other work up were unremarkable [echocardiogram, coronary angiogram, diagnostic electrophysiology study and later ¹⁸F-fluorodeoxyglucose (FDG) metabolism cardiac sarcoid positron emission tomography (PET) study]. An implantable cardiac monitor was implanted to monitor for recurrence of VT. Seven months after initial presentation, he had recurrent VT and he underwent implantation of an implantable cardioverter defibrillator (ICD). He has received appropriate ICD therapies on account of recurrent VT and he is currently maintained on an antiarrhythmic medication.

Excellent short-term outcomes have been reported in patients with COVID-19 vaccine associated myocarditis. Our case shows that long-term outcomes may not be benign in everyone, particularly in those who develop myocardial scar.