Is there an association between COVID-19 (Coronavirus Disease 2019) vaccine and sudden cardiac death?

From the Guidelines

There is no established causal link between COVID-19 vaccines and sudden cardiac death in the general population. Extensive safety monitoring of billions of administered doses has shown that while very rare cases of myocarditis (heart inflammation) can occur after mRNA vaccines, particularly in young males after the second dose, these cases are typically mild and resolve with treatment 1. The risk of cardiac complications is significantly higher from COVID-19 infection itself than from vaccination.

Key Points

• Vaccine-associated myocarditis should be diagnosed, categorized, and treated in a manner analogous to myocarditis following SARS-CoV-2 infection 1.
• COVID-19 vaccination is associated with a very favorable benefit-to-risk ratio for all age and sex groups evaluated thus far 1.
• For every 1,000 male individuals 12-29 years of age receiving a second dose of the COVID-19 mRNA vaccine, there are estimated to be 39-47 more cases of myocarditis, but also 560 fewer hospitalizations, 138 fewer ICU admissions, and 6 fewer deaths 1.

Recommendations

• If you experience chest pain, shortness of breath, or irregular heartbeat after vaccination, seek medical attention promptly, though such symptoms are more likely related to other causes.
• The immune response triggered by vaccines can cause temporary side effects like fatigue or fever, but these are normal signs that your body is building protection against the virus and typically resolve within a few days.
• Vaccine safety monitoring systems continue to track adverse events, but current evidence strongly supports that the benefits of COVID-19 vaccination outweigh the risks for all recommended age groups 1.

From the Research

Association between COVID-19 Vaccine and Sudden Cardiac Death

• There is no direct evidence to suggest a significant association between COVID-19 vaccination and sudden cardiac death 2, 3, 4, 5, 6.
• However, some studies have reported rare cases of myocarditis and pericarditis following COVID-19 vaccination, particularly in young males 3, 4, 5, 6.
• The risk of myocarditis and pericarditis is higher after mRNA COVID-19 vaccination, but the overall frequency is rare and the severity is usually mild 3, 4, 5, 6.
• A study found that the risk of myopericarditis, extrasystoles, and transient ischemic attack was transiently increased after COVID-19 vaccination, but full vaccination substantially reduced the risk of several more severe COVID-19-associated cardiovascular outcomes 2.
• Another study reported that the majority of patients with myocarditis or acute myocardial infarction following COVID-19 vaccination were men, and myocarditis patients were younger than acute myocardial infarction patients 5.
• The clinical course of myocarditis related to COVID-19 or mRNA vaccination appears to be mild and self-limiting, with reports of severe or fulminant myocarditis being rare 6.

Cardiovascular Events following COVID-19 Vaccination

• A nationwide Swedish study found that the risk of cardiovascular events, including myocarditis, pericarditis, dysrhythmias, heart failure, myocardial infarction, and cerebrovascular events, was decreased after COVID-19 vaccination, especially after the third dose 2.
• The study also found that the risk of extrasystoles and transient ischemic attack was slightly increased after COVID-19 vaccination, but the risk of arrhythmias and stroke was not significantly increased 2.
• A systematic review found that the estimated incidence of myocarditis in COVID-19 infection was 11 cases per 100,000 infections, compared with an estimated 2.7 cases per 100,000 persons following mRNA vaccination 6.

Management of Myocarditis following COVID-19 Vaccination

• The management of myocarditis following COVID-19 vaccination is supportive care for mild or moderate disease, and advanced heart failure therapies may be employed for severe disease 3, 4, 5, 6.
• Avoidance of strenuous exercise during the bout of myocarditis and its recovery phase is important 3, 4.
• Clinical guidance for appropriate use of cardiac investigations and monitoring in COVID-19 is needed for effective risk stratification and efficient use of cardiac resources 6.