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Updated: Sep 19, 2025

Isolation and Characterization of Cardiac Mesenchymal Stromal Cells from Endomyocardial Bioptic Samples of Arrhythmogenic Cardiomyopathy Patients
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Immune-related myocarditis characterized by malignant arrhythmia caused by conduction system involvement: case report

Luying Zhan1, Zhiquan Qin2, Liu Yang2

  • 1The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China.

Frontiers in Oncology
|June 16, 2025
PubMed

Immune checkpoint inhibitor (ICI)-related myocarditis has a low incidence but an extremely high mortality rate, and malignant arrhythmia caused by ICI therapy is even rarer. We report our experience of two patients with myocarditis with conduction system involvement after ICI therapy. Both patients developed myocarditis within a short period after the first ICI dose and they predominantly had conduction bundle involvement with minimal myocardial damage. One patient rapidly progressed from sinus rhythm to complete atrioventricular block, and the patient's symptoms improved only after pacemaker implantation. The other patient experienced paroxysmal ventricular tachycardia, which was controlled by synchronous corticosteroid therapy. Despite the strong immune side effects caused by ICIs, both patients achieved good clinical outcomes. We also conducted a literature search to explore the pathological mechanisms underpining immune-related myocarditis, as well as discussing the treatment strategies for immune-related myocarditis with conduction system involvement.

Keywords:
case reportimmune checkpoint inhibitorsimmune myocarditisimmune-related adverse eventsmethyl prednisolone

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