Electrocardiographic abnormalities and repolarization markers in children with Kawasaki disease: a systematic review...

Kawasaki disease (KD) is a leading cause of acquired pediatric heart disease, yet the prevalence and clinical significance of electrocardiographic (ECG) abnormalities during the acute phase remain unclear. To systematically evaluate ECG abnormalities in KD and their association with coronary artery aneurysm (CAA). MEDLINE/PubMed, EBM Reviews, and Embase were searched for observational studies reporting ECG findings in children (≤ 18 years) with acute KD. A meta-analysis evaluated the corrected QT interval (QTc) and Tp-e/QT ratio in patients with and without CAA. Sixteen observational studies (6,149 patients) were included, five of which were pooled in the meta-analysis, and 15 case reports. Reported ECG abnormalities included ST-segment/ST-T changes (5.6-30.8%), arrhythmias (0.4-15.6%), and pathological Q waves (0.6-72.0%). QTc was generally shorter in acute KD than in controls, whereas QT dispersion was increased, with higher values reported in some studies with CAA. Meta-analysis demonstrated no significant difference between patients with and without CAA regarding QTc (SMD 0.10, 95% CI - 0.44 to 0.64; p = 0.71; I²=79%) or Tp-e/QT ratio (SMD 0.79, 95% CI - 0.15 to 1.73; p = 0.10; I²=87%). Conventional ECG abnormalities are heterogeneous and inconsistent for diagnosing acute KD or detecting CAA. Dispersion-based repolarization parameters may reflect myocardial electrical instability, but their discriminatory value for coronary involvement remains uncertain due to nonsignificant pooled estimates and substantial heterogeneity. The spatial PR angle showed potential for CAA risk stratification, whereas the spatial QRS-T angle and RMS-T did not. Prospective studies using standardized ECG acquisition protocols are needed to validate these markers.