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Atrioventricular Conduction Abnormalities in Multisystem Inflammatory Syndrome in Children
Carlos A Carmona1, Fatma Levent2, Kelvin Lee3
1Advent Health for Children Pediatric Residency, Orlando, FL, USA.
Case Reports in Pediatrics
|October 4, 2021
Summary
Multisystem inflammatory syndrome in children (MIS-C) can cause heart problems, including conduction abnormalities. Early recognition and treatment with immunomodulatory therapies can effectively manage these cardiac issues in children with MIS-C.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious condition.
- Cardiac involvement is common in MIS-C, including coronary artery aneurysms and left ventricular dysfunction.
- Atrioventricular conduction abnormalities are a less commonly reported but significant cardiac manifestation.
Observation:
- Three pediatric patients with MIS-C presented with evolving atrioventricular conduction abnormalities.
- Patients developed bradycardia, PR prolongation, QTc elongation, and in some cases, third-degree heart block or junctional escape rhythms.
- Conduction abnormalities appeared after the initial hyperinflammatory phase, suggesting a post-inflammatory process affecting cardiac tissue.
Findings:
- Cardiac dysfunction and conduction abnormalities in MIS-C can be transient.
- Electrocardiographic changes, including PR and QTc prolongation, occurred approximately 8-9 days after symptom onset.
- Inflammatory markers (CRP, BNP) and cardiac biomarkers (troponin) showed distinct temporal patterns relative to ECG changes.
Implications:
- Prompt recognition and management of conduction abnormalities are crucial in pediatric MIS-C care.
- Immunomodulatory therapies (IVIG, steroids, anakinra, tocilizumab) were effective in resolving severe conduction disturbances.
- Understanding the timing of cardiac manifestations can guide monitoring and treatment strategies for MIS-C patients.
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