Incidence of arrhythmias and electrocardiographic abnormalities in symptomatic pediatric patients with PCR-positive SARS-CoV-2 infection, including drug-induced changes in the corrected QT interval

Abstract

BACKGROUND There is limited data regarding the electrophysiological abnormalities and arrhythmias in children with COVID-19, including those associated with treatment using potentially proarrhythmic hydroxychloroquine (HCQ) and azithromycin (AZN).OBJECTIVES To describe the electrophysiologic findings and arrhythmias associated with pediatric COVID-19 and its treatment.METHODS A single-center retrospective chart review was undertaken and included all patients with (1) symptoms of COVID-19 and (2) PCR-positive nasopharyngeal swabs for SARS-CoV-2 who were placed on continuous telemetry for the duration of their hospitalization during March through May, 2020.RESULTS Thirty-six patients were included in the study. Significant arrhythmias were found in 6 (nonsustained ventricular tachycardia in 5 and sustained atrial tachycardia in 1). All were self-resolving and half prompted prophylactic antiarrhythmic therapy. Patients with significant arrhythmias were likely to have noncardiac comorbidities (4/ 6), but these were not more common than in patients without arrhythmias (20/30, P 5 1). The use of HCQ was associated with statistically significant QTc prolongation (413 6 19 ms vs 425 6 16 ms, P 5.005). QTc was not statistically different in patients with and without arrhythmias (425 6 15 ms vs 425 6 15 ms, P 5 1).CONCLUSIONS In pediatric patients with PCR-positive active COVID-19 infection, significant arrhythmias are infrequent, but are more common than expected in a general pediatric population. Comorbidities are not more common in patients with arrhythmias than in patients without arrhythmias. COVID-19 treatment using HCQ is associated with QTc prolongation but was not associated with arrhythmias in pediatric patients.

Electrocardiographic Changes in Children with Multisystem Inflammation Associated with COVID-19

“…We had anticipated a limited overlap with findings in children and adult patients presenting with polymerase chain reaction-positive COVID-19 where arrhythmias had been seen in up to 16.7% of patients, but of particular concern in those with pre-existing cardiovascular morbidity. 20 , 21 , 22 , 23 We therefore undertook a systematic analysis of ECGs in this novel disease to focus on findings previously described in children affected by myopericarditis and Kawasaki disease. Indeed, with the exception of high-grade AV block, we showed significant overlap with these diseases.…”

Predictors and Prognostic Implications of Cardiac Arrhythmias in Patients Hospitalized for COVID-19

“…Thus, proarrhythmic effects of these drugs cannot be excluded in this cohort. Previous reports point towards significant prolongation of the QTc interval by hydroxychloroquine in COVID-19 which is even more enhanced in combination with azithromycin therapy [ 25 , 26 ]. However, the rate of associated ventricular arrhythmia has been low in these studies.…”

COVID-19 infection and cardiac arrhythmias

“…The data are even more limited regarding the electrophysiological abnormalities and arrhythmias in children with COVID-19 [ 89 , 90 ]. A recent study of 36 pediatric patients reported that significant arrhythmias were infrequent (albeit, more common than expected in a general pediatric population), observed in 6 children (NSVT in 5 and sustained atrial tachycardia in 1), all self-resolving; prophylactic antiarrhythmic therapy was employed in half [91] . Patients with significant arrhythmias were likely to have noncardiac comorbidities (4/6), but these were not more common than in patients without arrhythmias (20/30, p =1).…”