Electrocardiographic changes in non-hospitalised children with COVID-19

Abstract

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.

Prevalence and clinical presentation of long COVID in children: a systematic review

“…1 ). The types of studies were as follows: 12 cohort studies (8 prospective [ 13 , 14 , 17 – 22 ], 3 retrospective [ 23 – 25 ], and 1 ambidirectional [ 26 ]), 7 cross-sectional studies [ 27 – 33 ], and 3 case series [ 10 , 34 , 35 ]. Seven studies relied on direct assessed data [ 13 , 17 , 23 , 25 , 31 , 34 , 35 ], including one study with a control group [ 31 ].…”

“…The types of studies were as follows: 12 cohort studies (8 prospective [ 13 , 14 , 17 – 22 ], 3 retrospective [ 23 – 25 ], and 1 ambidirectional [ 26 ]), 7 cross-sectional studies [ 27 – 33 ], and 3 case series [ 10 , 34 , 35 ]. Seven studies relied on direct assessed data [ 13 , 17 , 23 , 25 , 31 , 34 , 35 ], including one study with a control group [ 31 ]. Fifteen studies were based on interviews or questionnaires, of these 2 were directed to paediatricians [ 28 , 30 ] and 13 to caregivers or patients [ 10 , 14 , 18 – 22 , 24 , 26 , 27 , 29 , 32 , 33 ] among these 8 provided a control group [ 18 – 20 , 22 , 24 , 26 , 32 , 33 ].…”

“…The clinical spectrum assessed across studies varied notably. The most frequently reported symptoms were the following: fatigue (2 [ 31 ] to 87% [ 28 ]), headache (3.5 [ 21 ] to 80% [ 19 ]), muscle or joint pain (0.7 [ 33 ] to 66% [ 14 ]), chest tightness or pain (1.3 [ 33 ] to 51% [ 25 ]), dyspnoea (2 [ 23 ] to 57.1% [ 34 ]), and taste or smell impairment (4.7 [ 21 ] to 84% [ 19 ]) (Fig. 5 ).…”

“…Electrocardiographic (ECG) abnormalities were described in a minority of COVID-19 outpatients, and none of the subjects affected had echocardiographic alterations. The ECG abnormalities resolved over time and were not associated with severity of acute disease [ 25 ].…”

“…In the present systematic review, 7 studies [ 13 , 17 , 23 , 25 , 31 , 34 , 35 ] with clinical data (including 549 children with history of SARS-CoV-2 infection) and 15 studies [ 10 , 14 , 18 – 22 , 24 , 26 – 30 , 32 , 33 ] based on interviews or questionnaires (including 28227 children with history of SARS-CoV-2 infection) were retrieved and analysed. Data are difficult to compare due to the large inter-study variability in terms of study design, follow-up timing, and definitions of long COVID which results in different inclusion criteria.…”