{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T18:59:55Z","timestamp":1790449195632,"version":"4.1.0"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T00:00:00Z","timestamp":1748563200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>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\u2019s 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.<\/jats:p>","DOI":"10.3389\/fonc.2025.1589990","type":"journal-article","created":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T05:47:45Z","timestamp":1748584065000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Immune-related myocarditis characterized by malignant arrhythmia caused by conduction system involvement: case report and literature review"],"prefix":"10.3389","volume":"15","author":[{"given":"Luying","family":"Zhan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiquan","family":"Qin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liu","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehac456","article-title":"Cardiovascular complications of immune checkpoint inhibitors for cancer","volume":"43","author":"Thuny","year":"2022","journal-title":"Eur Heart J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1016\/s0140-6736(18)30533-6","article-title":"Increased reporting of fatal immune checkpoint inhibitor-associated myocarditis","volume":"391","author":"Moslehi","year":"2018","journal-title":"Lancet"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1161\/jaha.119.013757","article-title":"Immune checkpoint inhibitor myocarditis: pathophysiological characteristics, diagnosis, and treatment","volume":"9","author":"Palaskas","year":"2020","journal-title":"J Am Heart Assoc"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/s1470-2045(18)30608-9","article-title":"Cardiovascular toxicities associated with immune checkpoint inhibitors: an observational, retrospective, pharmacovigilance study","volume":"19","author":"Salem","year":"2018","journal-title":"Lancet Oncol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1609214","article-title":"Fulminant myocarditis with combination immune checkpoint blockade","volume":"375","author":"Johnson","year":"2016","journal-title":"N Engl J Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1243","DOI":"10.3390\/diagnostics13071243","article-title":"Immune checkpoint inhibitors-related myocarditis: A review of reported clinical cases","volume":"13","author":"Zotova","year":"2023","journal-title":"Diagnostics (Basel)"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.esmoop.2023.100791","article-title":"Neuromuscular and cardiac adverse events associated with immune checkpoint inhibitors: pooled analysis of individual cases from multiple institutions and literature","volume":"8","author":"Boutros","year":"2023","journal-title":"ESMO Open"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.898756","article-title":"Successful therapy for myocarditis concomitant with complete heart block after pembrolizumab treatment for head and neck squamous cell carcinoma: A case report with literature review","volume":"9","author":"Su","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.bulcan.2018.07.005","article-title":"Physiopathological mechanisms of immune-related adverse events induced by anti-ctla-4, anti-pd-1 and anti-pd-L1 antibodies in cancer treatment","volume":"105","author":"Passat","year":"2018","journal-title":"Bull Cancer"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2018.10.014","article-title":"Immune-related adverse events predict the therapeutic efficacy of anti-pd-1 antibodies in cancer patients","volume":"109","author":"Rogado","year":"2019","journal-title":"Eur J Cancer"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1200\/jco.19.00318","article-title":"Analysis of the association between adverse events and outcome in patients receiving a programmed death protein 1 or programmed death ligand 1 antibody","volume":"37","author":"Maher","year":"2019","journal-title":"J Clin Oncol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.Ccr-07-0187","article-title":"Prognostic factors related to clinical response in patients with metastatic melanoma treated by ctl-associated antigen-4 blockade","volume":"13","author":"Downey","year":"2007","journal-title":"Clin Cancer Res"},{"key":"B13","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1186\/s40425-019-0805-8","article-title":"Immune-related adverse events and anti-tumor efficacy of immune checkpoint inhibitors","volume":"7","author":"Das","year":"2019","journal-title":"J Immunother Cancer"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1097\/CMR.0000000000000314","article-title":"New-onset third-degree atrioventricular block because of autoimmune-induced myositis under treatment with anti-programmed cell death-1 (Nivolumab) for metastatic melanoma","volume":"27","author":"Behling","year":"2017","journal-title":"Melanoma Res"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/8428210","article-title":"Pembrolizumab-induced mobitz type 2 second-degree atrioventricular block","volume":"2020","author":"Khan","year":"2020","journal-title":"Case Rep Cardiol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.revmed.2019.12.023","article-title":"Third degree atrio-ventricular blockade during a myocarditis occurring under anti-pd1: case report and literature review","volume":"41","author":"Prevel","year":"2020","journal-title":"Rev Med Interne"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.13545","article-title":"Keeping immune checkpoint inhibitor myocarditis in check: advanced circulatory mechanical support as a bridge to recovery","volume":"8","author":"Stein-Merlob","year":"2021","journal-title":"ESC Heart Fail"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e004699","DOI":"10.1136\/jitc-2022-004699","article-title":"Reversal of immune-checkpoint inhibitor fulminant myocarditis using personalized-dose-adjusted abatacept and ruxolitinib: proof of concept","volume":"10","author":"Nguyen","year":"2022","journal-title":"J Immunother Cancer"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1093\/ehjcr\/ytab342","article-title":"A case report of immune checkpoint inhibitor-related steroid-refractory myocarditis and myasthenia gravis-like myositis treated with abatacept and mycophenolate mofetil","volume":"5","author":"Jespersen","year":"2021","journal-title":"Eur Heart J Case Rep"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.21037\/cdt-21-147","article-title":"Checkpoint inhibitor-induced fulminant myocarditis, complete atrioventricular block and myasthenia gravis-a case report","volume":"11","author":"Portol\u00e9s Hern\u00e1ndez","year":"2021","journal-title":"Cardiovasc Diagn Ther"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1177\/03000605221133259","article-title":"Teriprizumab-induced myocarditis in a patient with cholangiocarcinoma: A case report","volume":"50","author":"Ye","year":"2022","journal-title":"J Int Med Res"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/4042909","article-title":"Camrelizumab-related lethal arrhythmias and myasthenic crisis in a patient with metastatic thymoma","volume":"2022","author":"Zhang","year":"2022","journal-title":"Case Rep Cardiol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000033550","article-title":"Immune checkpoint inhibitor sintilimab-induced lethal myocarditis overlapping with myasthenia gravis in thymoma patient: A case report","volume":"102","author":"Wang","year":"2023","journal-title":"Med (Baltimore)"},{"key":"B24","doi-asserted-by":"publisher","first-page":"e255698","DOI":"10.1136\/bcr-2023-255698","article-title":"Immune checkpoint inhibitor-associated myocarditis and fulminant type I diabetes in a patient with metastatic non-small cell lung cancer","volume":"16","author":"Davis","year":"2023","journal-title":"BMJ Case Rep"},{"key":"B25","doi-asserted-by":"publisher","first-page":"e43628","DOI":"10.7759\/cureus.43628","article-title":"An uncommon case of myocarditis secondary to durvalumab plus tremelimumab","volume":"15","author":"Diaz-Rodriguez","year":"2023","journal-title":"Cureus"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.7039","article-title":"Myocarditis and myasthenia gravis induced by immune checkpoint inhibitor in a patient with relapsed thymoma: A case report","volume":"11","author":"Zhong","year":"2023","journal-title":"Clin Case Rep"},{"key":"B27","doi-asserted-by":"publisher","first-page":"333","DOI":"10.3892\/etm.2024.12622","article-title":"Immune myocarditis induced by sintilimab therapy: A case report","volume":"28","author":"Li","year":"2024","journal-title":"Exp Ther Med"},{"key":"B28","doi-asserted-by":"publisher","first-page":"426","DOI":"10.3892\/etm.2024.12715","article-title":"Myasthenia gravis and myocarditis induced by chemoimmunotherapy in locally advanced gastric cancer: A case report","volume":"28","author":"Wang","year":"2024","journal-title":"Exp Ther Med"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2024.1336609","article-title":"Case report: temporary pacing using active fixation lead and invasive electrophysiology studies for immune checkpoint inhibitor associated reversible advanced atrioventricular block","volume":"11","author":"Wang","year":"2024","journal-title":"Front Cardiovasc Med"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1589990\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T05:47:46Z","timestamp":1748584066000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1589990\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,30]]},"references-count":29,"alternative-id":["10.3389\/fonc.2025.1589990"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2025.1589990","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,30]]},"article-number":"1589990"}}