McCullough PA, Hulscher N. Risk stratification for future cardiac arrest after COVID-19 vaccination. World J Cardiol 2025; 17(2): 103909 [DOI: 10.4330/wjc.v17.i2.103909]
Corresponding Author of This Article
Nicolas Hulscher, Senior Researcher, Department of Epidemiology, McCullough Foundation, 5231 Richard Avenue, Dallas, TX 75206, United States. nichulscher@gmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Feb 26, 2025; 17(2): 103909 Published online Feb 26, 2025. doi: 10.4330/wjc.v17.i2.103909
Risk stratification for future cardiac arrest after COVID-19 vaccination
Peter A McCullough, Nicolas Hulscher
Peter A McCullough, Department of Cardiology, McCullough Foundation, Dallas, TX 75206, United States
Nicolas Hulscher, Department of Epidemiology, McCullough Foundation, Dallas, TX 75206, United States
Author contributions: McCullough PA and Hulscher N were responsible for conceptualization, investigation, project administration, validation, visualization, writing – original draft, writing – review & editing.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nicolas Hulscher, Senior Researcher, Department of Epidemiology, McCullough Foundation, 5231 Richard Avenue, Dallas, TX 75206, United States. nichulscher@gmail.com
Received: December 4, 2024 Revised: January 14, 2025 Accepted: February 6, 2025 Published online: February 26, 2025 Processing time: 83 Days and 5.4 Hours
Abstract
Unheralded cardiac arrest among previously healthy young people without antecedent illness, months or years after coronavirus disease 2019 (COVID-19) vaccination, highlights the urgent need for risk stratification. The most likely underlying pathophysiology is subclinical myopericarditis and reentrant ventricular tachycardia or spontaneous ventricular fibrillation that is commonly precipitated after a surge in catecholamines during exercise or the waking hours of terminal sleep. Small patches of inflammation and/or edema can be missed on cardiac imaging and autopsy, and the heart can appear grossly normal. This paper reviews evidence linking COVID-19 vaccines to cardiac arrest where unfortunately the majority of victims have had no antecedent clinical evaluation. We propose a comprehensive strategy for evaluating cardiovascular risk post-vaccination, incorporating detailed patient history, antibody testing, and cardiac diagnostics in the best attempt to detect abnormalities before sudden cardiac death. This approach aims to identify individuals at higher risk of cardiac events after COVID-19 vaccination and guide appropriate clinical management. It is prudent for each primary care physician to have a pre-established plan when addressing this issue in their practice.
Core Tip: This study reviews evidence linking mRNA vaccines to cardiac pathology and proposes a comprehensive risk stratification approach involving patient history, antibody testing, and cardiac diagnostics. By identifying high-risk individuals through measurable endpoints like spike protein exposure and cardiac biomarkers, this approach seeks to guide clinicians in addressing the risks of myocarditis, arrhythmias, and cardiac arrest post-vaccination. Implementing this framework in primary care settings may improve cardiovascular outcomes and reduce preventable deaths.
