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Electrocardiographic changes in non-hospitalised children with COVID-19
Howard J Heching1,2, Anmol Goyal1, Brian Harvey2,3
1Ward Family Heart Center, Children's Mercy Kansas City, Kansas City, MO, USA.
Insights
Electrocardiographic changes were observed in a small percentage of children with mild COVID-19 who did not require hospitalization. Most of these cardiac findings resolved naturally, with no signs of myopericarditis detected on echocardiography.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Cardiac Electrophysiology
Background:
- COVID-19 affects children, with many experiencing asymptomatic, mild, or moderate illness not requiring hospitalization.
- Electrocardiographic (ECG) changes in pediatric COVID-19 patients without severe disease are not well-characterized.
- Assessing cardiac health in non-hospitalized pediatric COVID-19 cases is crucial for understanding potential long-term effects.
Purpose of the Study:
- To analyze electrocardiographic (ECG) changes in children with asymptomatic, mild, or moderate COVID-19 who did not require hospitalization.
- To identify the prevalence and nature of ECG abnormalities in this pediatric cohort.
- To investigate the association between ECG findings, disease severity, and Long COVID.
Main Methods:
- Retrospective analysis of ECGs from 82 children (age 1-18) with non-hospitalized COVID-19.
- Paediatric electrophysiologist assessed rhythm, chamber enlargement, hypertrophy, intervals (PR, QRS, QT), and ST-T wave abnormalities.
- Echocardiograms were reviewed for myopericarditis in patients with ECG abnormalities.
Main Results:
- Seventeen out of 82 children (21%) showed ECG changes, with 12% having borderline significance and 9% having concerning findings.
- No echocardiographic abnormalities indicative of myopericarditis were found in patients with ECG changes.
- Most ECG abnormalities resolved spontaneously over time; only two cases did not normalize.
- Neither greater COVID-19 disease severity nor Long COVID correlated with ECG abnormalities.
Conclusions:
- Electrocardiographic abnormalities occur in a minority of children with non-hospitalized COVID-19.
- The majority of identified ECG changes in pediatric COVID-19 patients are transient and resolve.
- Echocardiographic evaluation did not reveal evidence of myopericarditis in this cohort, suggesting a generally favorable cardiac outcome.
Objectives:
Many children diagnosed with COVID-19 infections did not require hospitalisation. Our objective was to analyse electrocardiographic changes in children with asymptomatic, mild or moderate COVID-19 who did not require hospitalisation.
Methods:
All children are seen in a paediatric cardiology clinic who had asymptomatic, mild or moderate COVID-19 that did not require hospitalisation and had at least one electrocardiogram after their diagnosis were included in this retrospective analysis. Records were reviewed to determine COVID-19 disease severity and presence of Long COVID. Rhythm assessment, atrial enlargement, ventricular hypertrophy, PR/QRS/QT interval duration and ST-T wave abnormalities were analysed by a paediatric electrophysiologist. Clinically ordered echocardiograms were reviewed for signs of myopericarditis (left ventricular ejection fraction and pericardial effusion) on any subject with an electrocardiographic abnormality.
Results:
Of the 82 children meeting inclusion criteria (14.4 years, range 1-18 years, 57% male), 17 patients (21%) demonstrated electrocardiographic changes. Ten patients (12%) had electrocardiogram of borderline significance, which included isolated mild PR prolongation or mild repolarisation abnormalities. The other seven patients (9%) had concerning electrocardiographic findings consisting of more significant repolarisation abnormalities. None of the patients with an abnormal electrocardiogram revealed any echocardiographic abnormality. All abnormal electrocardiograms normalised over time except in two cases. Across the entire cohort, greater COVID-19 disease severity and long COVID were not associated with electrocardiographic abnormalities.
Conclusions:
Electrocardiographic abnormalities are present in a minority of children with an asymptomatic, mild or moderate COVID-19 infection. Many of these changes resolved over time and no evidence of myopericarditis was present on echocardiography.
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