Electrocardiographic Changes and Arrhythmia Spectrum in Pediatric Patients with Acute Myocarditis

Abstract

Objective: Myocarditis is a non-ischemic inflammation of the cardiac muscle and causes non-specific and variable electrocardiographic (ECG) changes, indicating the inflammatory process. In this study, we aimed to investigate the prevalence and nature of ECG changes and arrhythmias in patients diagnosed with acute myocarditis (AM). Materials and Methods:This retrospective study included 75 patients diagnosed with AM between January 1, 2020, and December 31, 2022, at our institution. The diagnosis was based on clinical symptoms, laboratory findings, and imaging procedures.Results: Of the 75 AM patients evaluated, 67 (89.3%) were male, with a median age of 15 years. The primary symptom was chest pain (89.3%). The peaking times of Troponin I levels varied in presentation times. Elevated creatine kinase-MB and C-reactive protein levels were observed in 62.7% and 78.7% of patients, respectively. Viral serology identified COVID-19, Coxsackievirus, influenza, and parainfluenza as common viruses. ECG and Holter abnormalities were found in 82.7% of patients, with ST-segment elevation, T-wave abnormalities, sinus tachycardia, and interventricular conduction delay being the most common. Extracorporeal membrane oxygenation therapy was required in two critical cases, unfortunately resulting in the deaths of both patients. Conclusion:Myocarditis presents with varied etiology and manifestations. ECG changes and arrhythmias are commonly observed in patients with this condition. Despite comprehensive care, severe cases can lead to adverse outcomes.