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High specificity electrocardiogram patterns for parvovirus B19 myocarditis in children: bridging electrocardiogram

Roger Esmel-Vilomara^1,2,3, Paola Dolader^1,2, Susana Melendo^1,4

¹Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.

Cardiology in the Young

|May 8, 2025

Insights

A specific electrocardiogram pattern, including peaked P waves and low QRS voltages, can help identify Parvovirus B19 (PVB19) myocarditis in children. This finding may aid in early diagnosis of this serious heart condition.

Area of Science:

Pediatric Cardiology
Infectious Diseases
Diagnostic Electrocardiography

Background:

Parvovirus B19 (PVB19) myocarditis is a severe pediatric condition with high mortality.
Electrocardiograms (ECGs) are crucial for myocarditis assessment, but no specific PVB19 pattern exists.
This study aimed to find a distinct ECG pattern for PVB19 myocarditis and assess its diagnostic accuracy.

Purpose of the Study:

Identify a unique electrocardiogram (ECG) pattern associated with Parvovirus B19 (PVB19) myocarditis in children.
Evaluate the diagnostic accuracy of the identified ECG pattern for PVB19 myocarditis.

Main Methods:

Retrospective case-control study of 77 pediatric patients with acute myocarditis.
Compared 20 PVB19 myocarditis cases (PCR or biopsy confirmed) with 57 other viral myocarditis cases.
ECGs were analyzed by three blinded cardiologists.

Main Results:

A specific ECG pattern (peaked P waves, low QRS voltage, altered repolarization) was found in 70% of PVB19 myocarditis patients.
This pattern showed 98% specificity and 70% sensitivity for PVB19 myocarditis.
Only 1.75% of non-PVB19 myocarditis cases exhibited the full pattern.

Conclusions:

An identified ECG pattern demonstrates high diagnostic specificity for pediatric PVB19 myocarditis.
This ECG pattern could serve as an early diagnostic tool for PVB19 myocarditis.
Further multicenter studies are recommended to validate findings and explore clinical implications.

Read full analysis

Abstract

Introduction:

Parvovirus B19 (PVB19) myocarditis is a life-threatening condition with high morbidity and mortality in children. While electrocardiograms are commonly used in the early assessment of myocarditis, no specific electrocardiogram pattern has been consistently linked to PVB19. The objective of this study is to identify a distinctive electrocardiogram pattern associated with PVB19 myocarditis and evaluate its diagnostic accuracy.

Methods:

This retrospective case-control study included 77 paediatric patients diagnosed with acute myocarditis at a single centre in Barcelona over 16 years (August 2008-September 2024). Twenty patients had PVB19 myocarditis, confirmed by polymerase chain reaction in blood or endomyocardial biopsy, while 57 patients had myocarditis caused by other viruses. Electrocardiogram were assessed by three cardiologists blinded to the aetiological diagnosis.

Results:

A specific electrocardiogram pattern in the limb leads, characterised by peaked P waves, low QRS complex voltages, and altered repolarisation (manifesting as negative or flat T waves, with or without QTc prolongation), was observed in 14 of 20 patients (70%) with PVB19 myocarditis. Two additional patients exhibited low voltages and altered repolarisation without peaked P waves, and all demonstrated repolarisation abnormalities. In contrast, only 1 of 57 patients with myocarditis from other viruses exhibited the full electrocardiogram pattern. The pattern demonstrated a specificity of 98% and a sensitivity of 70% for PVB19 myocarditis.

Conclusion:

The identified electrocardiogram pattern shows strong diagnostic specificity for PVB19 myocarditis in paediatric patients and may serve as a useful early diagnostic tool. Further multicentre studies are needed to confirm these findings and explore their clinical implications.

Keywords:

Myocarditis cardiogenic shock electrocardiogram heart failure parvovirus B19

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