Implantable Cardioverter-Defibrillators for Secondary Prevention in Giant Cell Myocarditis

Giant cell myocarditis (GCM) presents significant challenges in clinical management, particularly regarding the role of implantable cardioverter-defibrillators (ICDs) for secondary prevention of ventricular tachycardia (VT). We present the case of a 42-year-old female patient with histologically confirmed GCM who underwent orthotopic heart transplantation and subsequently developed VT due to biopsy-proven recurrent GCM within one year after transplant. An ICD was placed for secondary prevention following multiple episodes of monomorphic nonsustained VT. The patient would then present to the hospital for an ICD shock with device interrogation showing one episode of sustained VT. On further work-up, the patient was found to have a biopsy-proven recurrence of GCM. In this context, we review the existing literature, primarily case reports, small case series, and registry data, pertaining to ICD use in GCM. Our case underscores the lack of standardized guidelines and limited high-quality data supporting ICD placement in this population. It highlights the importance of individualized decision-making and contributes to clinical discussions by emphasizing the potential role of ICDs in managing life-threatening arrhythmias associated with both native and recurrent GCM.