Late occurrence of ChAdOx1 vaccine-induced myocarditis presenting with ventricular arrhythmia

Abstract

A 51-year-old woman who had received 2 injections of a ChAdOx1 vaccine in 2021 and a booster dose in 2022 was recently admitted for central chest pain accompanied with palpitations for the previous 2 weeks. She was negative for the COVID-19 virus, troponin was not elevated, both the 12-lead electrocardiogram and 2D echocardiogram were normal. At peak exercise during exercise treadmill test she developed a single ventricular couplet, but coronary angiography revealed normal coronary arteries. A 24-hour electrocardiogram recording revealed symptomatic non-sustained ventricular tachycardia while she was in bed. A 3T cardiac magnetic resonance imaging (MRI) demonstrated late gadolinium sub-epicardial uptake at the left ventricle apex suggesting fibrosis. The patient was diagnosed as late presentation of myocarditis following ChAdOx1 vaccination, and was discharged on oral amiodarone and colchicine.