Tachyarrhythmias During Hospitalization for COVID-19 or Multisystem Inflammatory Syndrome in Children and Adolescents
Audrey Dionne1, Kevin G Friedman1, Cameron C Young2
1Department of Cardiology Boston Children's Hospital Department of Pediatrics Harvard Medical School Boston MA.
Insights
Tachyarrhythmias are rare but serious cardiac complications in children hospitalized with severe COVID-19 or multisystem inflammatory syndrome. These arrhythmias were linked to increased illness severity, longer hospital stays, and higher mortality rates.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Cardiac complications in pediatric COVID-19 include ventricular dysfunction, myocarditis, and bradyarrhythmias, with tachyarrhythmias being less understood.
- This study focuses on the incidence, characteristics, and outcomes of tachyarrhythmias in pediatric patients hospitalized with severe COVID-19 or multisystem inflammatory syndrome in children (MIS-C).
Purpose of the Study:
- To determine the frequency and clinical features of tachyarrhythmias in children and adolescents hospitalized with acute severe COVID-19 or MIS-C.
- To compare outcomes of pediatric patients with and without tachyarrhythmias during hospitalization for these conditions.
Main Methods:
- A case series analysis of 63 pediatric patients (<21 years) with tachyarrhythmias, identified through a US public health surveillance registry from March 2020 to December 2021.
- Comparison of patients with tachyarrhythmias against those with severe COVID-19 complications but without tachyarrhythmias.
- Analysis included types of tachyarrhythmias, interventions required, and patient demographics and outcomes.
Main Results:
- Tachyarrhythmias occurred in 1.8% of acute COVID-19 patients and 1.7% of MIS-C patients.
- Supraventricular tachycardia (44%), accelerated junctional rhythm (14%), and ventricular tachycardia (60%) were common; 19% had multiple types.
- Patients with tachyarrhythmias were older, had higher illness severity, required interventions (medication, cardioversion, CPR, ECMO), experienced longer hospital stays, and had a higher mortality rate (14% vs. 2%).
Conclusions:
- Tachyarrhythmias are infrequent but significant complications in pediatric severe COVID-19 and MIS-C.
- The presence of tachyarrhythmias is associated with poorer clinical outcomes, including increased mortality.
- Close monitoring, prompt treatment, and comprehensive post-discharge care are crucial for affected pediatric patients.
Abstract:
Background Cardiac complications related to COVID-19 in children and adolescents include ventricular dysfunction, myocarditis, coronary artery aneurysm, and bradyarrhythmias, but tachyarrhythmias are less understood. The goal of this study was to evaluate the frequency, characteristics, and outcomes of children and adolescents experiencing tachyarrhythmias while hospitalized for acute severe COVID-19 or multisystem inflammatory syndrome in children. Methods and Results This study involved a case series of 63 patients with tachyarrhythmias reported in a public health surveillance registry of patients aged <21 years hospitalized from March 15, 2020, to December 31, 2021, at 63 US hospitals. Patients with tachyarrhythmias were compared with patients with severe COVID-19-related complications without tachyarrhythmias. Tachyarrhythmias were reported in 22 of 1257 patients (1.8%) with acute COVID-19 and 41 of 2343 (1.7%) patients with multisystem inflammatory syndrome in children. They included supraventricular tachycardia in 28 (44%), accelerated junctional rhythm in 9 (14%), and ventricular tachycardia in 38 (60%); >1 type was reported in 12 (19%). Registry patients with versus without tachyarrhythmia were older (median age, 15.4 [range, 10.4-17.4] versus 10.0 [range, 5.4-14.8] years) and had higher illness severity on hospital admission. Intervention for treatment of tachyarrhythmia was required in 37 (59%) patients and included antiarrhythmic medication (n=31, 49%), electrical cardioversion (n=11, 17%), cardiopulmonary resuscitation (n=8, 13%), and extracorporeal membrane oxygenation (n=9, 14%). Patients with tachyarrhythmias had longer hospital length of stay than those who did not, and 9 (14%) versus 77 (2%) died. Conclusions Tachyarrhythmias were a rare complication of acute severe COVID-19 and multisystem inflammatory syndrome in children and adolescents and were associated with worse clinical outcomes, highlighting the importance of close monitoring, aggressive treatment, and postdischarge care.
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