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. 2021 Jul:234:27-32.e2.
doi: 10.1016/j.jpeds.2020.12.033. Epub 2021 Jan 13.

Electrocardiographic Changes in Children with Multisystem Inflammation Associated with COVID-19: Associated with Coronavirus Disease 2019

William Regan  1 , Laura O'Byrne  2 , Kirsty Stewart  2 , Owen Miller  3 , Kuberan Pushparajah  4 , Paraskevi Theocharis  2 , James Wong  2 , Eric Rosenthal  2
Affiliations

Electrocardiographic Changes in Children with Multisystem Inflammation Associated with COVID-19: Associated with Coronavirus Disease 2019

William Regan et al. J Pediatr. 2021 Jul.

Abstract

Objective: To analyze findings and trends on serial electrocardiograms (ECGs) in multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease taken during the course of illness and at follow-up.

Study design: We included all children presenting with MIS-C at a single center with 3 or more ECGs taken during the course of their illness. We measured ECG intervals (PR, QRSd, and QTc) and amplitudes (R-, S-, and T-waves) on each ECG and documented any arrhythmias and ST-segment changes.

Results: A majority of children (n = 42, 67%) showed ECG changes. The most common findings were low QRS amplitudes and transient T-wave inversion. ST changes were uncommon and included ST-segment elevation consistent with pericarditis in 1 child and acute coronary ischemia in 1 child. Arrhythmias were seen in 13 children (21%) but were benign with the exception of 1 child who was compromised by an atrial tachycardia requiring support with extracorporeal membrane oxygenation. No children were found to have high-grade atrioventricular block.

Conclusions: MIS-C is associated with electrocardiographic changes over the course of the illness, with low amplitude ECGs on presentation, followed by transient T-wave inversion, particularly in the precordial leads. There was a low prevalence of ST-segment changes and tachyarrhythmias.

Keywords: MIS-C; PIMS; SARS-CoV-2; arrhythmias; coronavirus; pediatric.

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Figures

Figure 3
Figure 3
Representative ECG changes. Typical pattern of transient T-wave flattening and inversion with QRS amplitude changes A, on admission, B, midpoint, C, discharge, and D, follow-up in same patient. ST-segment elevation in 2 children E, lateral ST-segment elevation with chest pain because of subendocardial myocardial infarction in the territory supplied by left anterior descending and circumflex arteries. F, Pericarditis pattern of ST-segment elevation with concave ST-segment elevation.
Figure 1
Figure 1
Lateral repolarization changes during MIS-C illness. T-wave amplitudes over course of illness in V6 and Lead I (mv), with T/R ratio in V6 demonstrating the predominant amplitude changes are seen in T-waves in this lead.
Figure 2
Figure 2
Summary of electrocardiographic changes during MIS-C illness. T-wave changes seen during illness, represented across timeline of clinical events and investigations (x-axis showing median days since symptom onset). GLS, global longitudinal strain.
Figure 4
Figure 4
ECG intervals: Prolongation during MIS-C. ECG intervals (PR, QRS duration [QRSd], and corrected QT [QTc]) showing prolongation (>98th percentile for age), expressed as percentage of cohort affected at each time point.
See this image and copyright information in PMC

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References

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Supplementary concepts