High-grade heart block requiring transvenous pacing associated with multisystem inflammatory syndrome in children during the COVID-19 pandemic

Domico, Michele; McCanta, Anthony C.; Hunt, J. N.; Ashouri, Negar; Nugent, Diane J.; Kelly, Robert B.

doi:10.1016/j.hrcr.2020.08.015

Cited by 19 publications

(26 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results of when the initial bradyarrhythmia occurred are postpeak of inflammatory markers like El-Assaad et al reports [10]. In addition to severe local inflammation, insufficiency of the coronary arterial supply to the atrioventricular node and specialized conduction system are the presumed mechanisms of the conduction system abnormalities [12].…”

Section: Discussionsupporting

confidence: 60%

“…Boston Children's Hospital had a retrospective cohort of 25 MIS-C cases where AV blocks were analyzed, and it was noted that first-degree heart blocks typically progressed to high-grade AV blocks [11]. Dominco et al described a patient with second-degree type 2 AV block with periods of an idioventricular rhythm who needed emergent transvenous bipolar pacing [12].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Atrioventricular Conduction Abnormalities in Multisystem Inflammatory Syndrome in Children

Carmona

Levent

Lee

et al. 2021

Case Reports in Pediatrics

View full text Add to dashboard Cite

Cardiac manifestations in multisystem inflammatory syndrome in children (MIS-C) can include coronary artery aneurysms, left ventricular systolic dysfunction, and electrocardiographic disturbances. We report the clinical course of three children with MIS-C while focusing on the unique considerations for managing atrioventricular conduction abnormalities. All initially had normal electrocardiograms but developed bradycardia followed by either PR prolongation or QTc elongation. Two had mild left ventricular ejection fraction dysfunction prior to developing third-degree heart block and/or a junctional escape rhythm; one had moderate left ventricular systolic dysfunction that normalized before developing a prolonged QTc. On average, our patients presented to the hospital 4 days after onset of illness. Common presenting symptoms included fevers, abdominal pain, nausea, and vomiting. Inflammatory and coagulation factors were their highest early on, and troponin peaked the highest within the first two days; meanwhile, peak brain-natriuretic peptide occurred at hospital days 3-4. The patient’s lowest left ventricular ejection fraction occurred at days 5-6 of illness. Initial electrocardiograms were benign with PR intervals below 200 milliseconds (ms); however, collectively the length of time from initial symptom presentation till when electrocardiographic abnormalities began was approximately days 8-9. When comparing the timing of electrocardiogram changes with trends in c-reactive protein and brain-natriuretic peptide, it appeared that the PR and QTc elongation patterns occurred after the initial hyperinflammatory response. This goes in line with the proposed mechanism that such conduction abnormalities occur secondary to inflammation and edema of the conduction tissue as part of a widespread global myocardial injury process. Based on this syndrome being a hyperinflammatory response likely affecting conduction tissue, our group was treated with different regimens of intravenous immunoglobulin, steroids, anakinra, and/or tocilizumab. These medications were successful in treating third-degree heart block, prolonged QTc, and a junctional ectopic rhythm.

show abstract

Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Atrioventricular Conduction Abnormalities in Multisystem Inflammatory Syndrome in Children

Carmona

Levent

Lee

et al. 2021

Case Reports in Pediatrics

View full text Add to dashboard Cite

show abstract

“… 2 , 3 , 4 , 5 , 6 , 7 , 14 One small cohort study noted 9 of 15 children (60%) with abnormal electrocardiogram (ECG) findings. 5 A large US cohort reported a 12% rate of arrhythmia, but with no further details of type or outcome, 9 and 1 case report described a transient, high-grade AV block requiring pacing in a child with MIS-C. 15 …”

mentioning

confidence: 99%

Electrocardiographic Changes in Children with Multisystem Inflammation Associated with COVID-19

Regan

O’Byrne

Stewart

et al. 2021

The Journal of Pediatrics

View full text Add to dashboard Cite

Objective To analyze findings and trends on serial electrocardiograms (ECGs) in multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease taken during the course of illness and at follow-up. Study designWe included all children presenting with MIS-C at a single center with 3 or more ECGs taken during the course of their illness. We measured ECG intervals (PR, QRSd, and QTc) and amplitudes (R-, S-, and T-waves) on each ECG and documented any arrhythmias and ST-segment changes.Results A majority of children (n = 42, 67%) showed ECG changes. The most common findings were low QRS amplitudes and transient T-wave inversion. ST changes were uncommon and included ST-segment elevation consistent with pericarditis in 1 child and acute coronary ischemia in 1 child. Arrhythmias were seen in 13 children (21%) but were benign with the exception of 1 child who was compromised by an atrial tachycardia requiring support with extracorporeal membrane oxygenation. No children were found to have high-grade atrioventricular block.Conclusions MIS-C is associated with electrocardiographic changes over the course of the illness, with low amplitude ECGs on presentation, followed by transient T-wave inversion, particularly in the precordial leads. There was a low prevalence of ST-segment changes and tachyarrhythmias.

show abstract

“…The bradyarrhythmias observed in COVID‐19 include SSS, sinus node disfunction, second and third degree AVB. Although not completely elucidated, the pathogenesis of bradyarrhythmias has been explained with several conditions occurring during SARS‐CoV‐2 infection, such as increased level of ACE‐2, 15,16,31 direct injury of virus to cardiac cells, 6,20,29–33 hyperinflammatory status, 6,16,17,21,22,27,31 hypoxemia and electrolytic disorders, 19,21,29 imbalance of autonomic nervous system likely due to involvement of nervous system by virus infection 6,19 and side effect of medications 24–26 . A pivotal role is represented by the pro‐inflammatory cytokine IL‐6, which is the main responsible for cytokine storm during COVID and also is able to imbalance autonomic nervous system increasing vagal tone 36,37 (Figure 2).…”

Section: Review Of the Literaturementioning

confidence: 99%

Bradyarrhythmias in patients with SARS‐CoV‐2 infection: A narrative review and a clinical report

Gatto¹,

Persi²,

Tung³

et al. 2021

Pacing Clinical Electrophis

View full text Add to dashboard Cite

Several cardiovascular diseases and arrhythmic disorders have been described in COVID‐19 era as likely related to SARS‐CoV‐2 infection. The prognostic relevance of bradyarrhythmias during the infection has not been yet described and no data are available about long‐term heart conduction disorders. A review of literature concerning the association between hypokinetic arrhythmias and COVID‐19 from January 2020 to February 2021 was performed. The key‐words used for the research were: “sinus node disfunction,” “sick sinus syndrome (SSS),” “sino‐atrial block,” “atrio‐ventricular block (AVB),” “bradyarrhythmias,” and “COVID‐19″ or ”SARS‐CoV‐2.″ Excluding “relative bradycardia,” a total of 38 cases of bradyarrhythmia related to SARS‐CoV‐2 infection have been described, even in very young people, requiring in many cases a definitive pacemaker implantation. Furthermore, we report a case of non‐hospitalized 47‐years old man with a SSS developed as a consequence of mild SARS‐CoV‐2 infection. While in all described cases heart conduction disorders were found at presentation of the infection or during hospitalization for COVID‐19, in our case the diagnosis of SSS was made after the resolution of the infection. Although rarely, heart conduction disorders may occur during COVID‐19 and the present case highlights that a cardiological follow up may be desirable even after the resolution of infection, especially in the presence of symptoms suggesting a possible heart involvement.

show abstract

High-grade heart block requiring transvenous pacing associated with multisystem inflammatory syndrome in children during the COVID-19 pandemic

Cited by 19 publications

References 11 publications

Atrioventricular Conduction Abnormalities in Multisystem Inflammatory Syndrome in Children

Atrioventricular Conduction Abnormalities in Multisystem Inflammatory Syndrome in Children

Electrocardiographic Changes in Children with Multisystem Inflammation Associated with COVID-19

Bradyarrhythmias in patients with SARS‐CoV‐2 infection: A narrative review and a clinical report

Contact Info

Product

Resources

About