Arrhythmia spectrum and outcome in children with myocarditis

Abstract

Introduction : Myocarditis remains an under-diagnosed entity among children. We evaluated the spectrum of electrocardiogram (ECG) changes and arrhythmias in children with myocarditis. Methods : A single-center prospective observational study was conducted over a period of 18 months at a public university hospital, which included all cases with myocarditis from the ages of 1 month to 12 years. Myocarditis was diagnosed according to standard criteria. Arrhythmias were detected by 12-lead ECG or by multiparameter monitors. Results : There were 63 children with myocarditis. Sinus tachycardia remained the most important ECG finding (61, 96.8%) followed by ST-T changes (30, 47.6%), low voltage QRS complexes (23, 36.5%), and premature complexes (11, 17.4%). Sustained arrhythmias were seen in 14/63 (22.2%) of the children (Group A), while the remaining 49 patients were designated as Group B. There were 11 (17.5%) cases with sustained tachyarrhythmias, comprising 5 with supraventricular tachycardia, 4 with ventricular tachycardia, and 2 with atrial flutter/fibrillation. Bradyarrhythmias were seen in 3 patients, including 2 children with atrioventricular block and 1 with severe sinus bradycardia. A longer hospital stay of 18.5 (4.75) days vs. 13 (4) days, P = 0.001), and more ST-T changes [12 (85.7%) vs. 18 (36.73%), P = 0.003] were seen in Group A. Multivariate regression analysis found only the presence of ST-T changes as predictors for arrhythmia. Conclusions : A variety of arrhythmias and other ECG changes were commonly seen in children with myocarditis. Sustained arrhythmias were seen in one-fifth of the patients, being associated with ST-T changes and a longer hospital stay.

Clinical Presentation, Diagnosis, Treatment, and Outcomes of Myocarditis in Children: A Tertiary Care Hospital Experience

“…None of the patients in our group developed arrhythmias; this is in contrast to other studies. In one instance, a study on the spectrum of arrhythmias and outcomes in pediatric myocarditis discovered that a considerable proportion of these patients had aberrant ECG readings, including sinus tachycardia [ 16 ]. Different arrhythmia patterns have also been noted in viral myocarditis patients, with ventricular arrhythmias aggravating the disease's clinical course and affecting prognosis [ 17 ].…”

Congenital Anomalous Origin of the Coronary Artery in Children: Use of Computed Tomography Coronary Angiography for Diagnosis

“…Myocardial cells and interstitial oedema can lead to reduced blood ow through the coronary artery and corresponding manifestations. In Rasal's study, sinus tachycardia (96.8%) was the most frequent ECG change in children with myocarditis, followed by nonspeci c ST-T wave changes (47.6%) (15). According to the American Heart Association statement for the diagnosis and management of myocarditis in children, about two-thirds of children with myocarditis have a history of a preceding viral prodrome and >50% have fever (16), which can differentiate myocarditis from AOCA.…”

Electrocardiographic Changes and Arrhythmia Spectrum in Pediatric Patients with Acute Myocarditis

“…[2,4,6] Troponin I, CK-MB, and CRP levels were raised in our patients, indicating myocardial damage and inflammatory responses, substantiating their utility in diagnosing myocarditis. [2,5,8] Patients suffering from myocarditis may also exhibit signs of heart failure, such as dyspnea and fatigue, due to impaired cardiac function. Fatigue was observed in a minority of instances, consistent with the literature indicating that it is a less common presenting symptom.…”

“…[1,2,[4][5][6] Indeed, in infants, the disease often presents as a respiratory or gastrointestinal disorder, thus evading easy diagnosis. [1,7,8] Notably, the clinical presentations of myocarditis can be quite varied. The clinical spectrum is broad, from asymptomatic cases to those with severe symptoms such as chest pain, arrhythmias, heart failure, or even sudden death.…”

“…The clinical spectrum is broad, from asymptomatic cases to those with severe symptoms such as chest pain, arrhythmias, heart failure, or even sudden death. [2,4,5,8] One of the critical concerns in managing myocarditis is the high prevalence of arrhythmias observed in 29-45% of initial patient consultations and up to 100% in severe cases of acute myocarditis (AM). [3,8,9,10] The primary aim of this study is to investigate the prevalence and nature of electrocardiographic (ECG) changes and arrhythmias in patients diagnosed with AM.…”