Acute myocarditis (AM) complicated by ventricular arrhythmias (VA) carries an uncertain risk of VA recurrence after discharge. Predictors are poorly defined, complicating risk stratification and implantable cardioverter defibrillator (ICD) decision-making. To assess recurrence rates and identify predictors of major arrhythmic events (MAE) after AM complicated by sustained VA. This systematic review and meta-analysis was registered in PROSPERO (CRD420250594422). PubMed, Web of Science, and Cochrane Library were searched up to December 2024 for studies reporting post-discharge VA recurrence in patients with AM complicated by VA in the acute phase. Unpublished data were obtained from study authors to restrict analysis to sustained ventricular tachycardia (VT) and ventricular fibrillation (VF). The primary outcome was MAE at follow-up (documented sustained VA, appropriate ICD therapy or sudden cardiac death). Pooled recurrence rates and predictors were assessed using random-effects models. Eight observational studies (n=355) were analyzed. MAE occurred in 46.4% (95% CI 38.1-54.9; I2=50.0) during a mean pooled follow-up of 3.8 years (95% CI 2.7-5.1). Neither demographic factors (age, sex), comorbidities, cardiovascular risk factors nor ICD implantation prior to discharge were associated with MAE at follow-up. Reduced left ventricular ejection fraction and the presence or localization of late gadolinium enhancement on cardiac magnetic resonance were also not predictive. MAE recurrences after AM affect nearly half of patients with sustained VA during the acute phase. No consistent predictors emerged. These findings are consistent with the ESC guidelines and call for refined risk stratification from large, multicenter cohorts with standardized criteria.