PMC8192838_01
Basal electrocardiogram made at the patient's admission. Electrocardiogram showing absence of atrial electrical activity, idioventricular rhythm with 30 beats per minute heart rate.
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The electrocardiogram showed non-sinus rhythm, sinus arrest with idioventricular leakage of 35 bpm with QRS around 150 ms with the morphology of right bundle branch block with extreme right axis deviation (Fig. 1). According to histopathological analysis, the sample was not compatible with acute inflammation and no residual fibrosis was found (supplementary Fig. 1).
Cardiac MRI during acute myocarditis. Semiquantitative post gadolinium analysis during T1 sequence. Mesoepicardic myocardial fibrosis with non-coronary pattern in the left ventricle middle portion free lateral wall. Estimated fibrosis burden: 2%.
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The contractile mechanical improvement without any amelioration of the rhythm and heart rate plus the need to stratify the severity of the conduction system is not clearly explained by the cardiac MRI findings (Fig. 2).