Tachyarrhythmias During Hospitalization for COVID‐19 or Multisystem Inflammatory Syndrome in Children and Adolescents

Author:

Dionne Audrey1ORCID,Friedman Kevin G.1,Young Cameron C.2ORCID,Newhams Margaret M.2,Kucukak Suden2,Jackson Ashley M.3,Fitzgerald Julie C.4,Smallcomb Laura S.5ORCID,Heidemann Sabrina6ORCID,McLaughlin Gwenn E.7,Irby Katherine8,Bradford Tamara T.9ORCID,Horwitz Steven M.10,Loftis Laura L.11,Soma Vijaya L.12,Rowan Courtney M.13ORCID,Kong Michele14ORCID,Halasa Natasha B.15,Tarquinio Keiko M.16ORCID,Schwarz Adam J.17,Hume Janet R.18ORCID,Gertz Shira J.19,Clouser Katharine N.20,Carroll Christopher L.21,Wellnitz Kari22,Cullimore Melissa L.23ORCID,Doymaz Sule24,Levy Emily R.25ORCID,Typpo Katri V.26,Lansell Amanda N.27ORCID,Butler Andrew D.28ORCID,Kuebler Joseph D.29ORCID,Zambrano Laura D.3ORCID,Campbell Angela P.3ORCID,Patel Manish M.3,Randolph Adrienne G.230ORCID,Newburger Jane W.1ORCID,

Affiliation:

1. Department of Cardiology Boston Children’s Hospital Department of Pediatrics Harvard Medical School Boston MA

2. Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children’s Hospital Boston MA

3. COVID‐19 Response, Centers for Disease Control and Prevention Atlanta GA

4. Division of Critical Care Department of Anesthesiology and Critical Care University of Pennsylvania Perelman School of Medicine Philadelphia PA

5. Department of Pediatrics Medical University of South Carolina Charleston SC

6. Division of Pediatric Critical Care Medicine, Department of Pediatrics Central Michigan University Detroit MI

7. Division of Pediatric Critical Care Medicine Department of Pediatrics University of Miami Miller School of Medicine Miami FL

8. Section of Pediatric Critical Care Department of Pediatrics Arkansas Children’s Hospital Little Rock AR

9. Division of Cardiology, Department of Pediatrics Louisiana State University Health Sciences Center and Children’s Hospital of New Orleans New Orleans LA

10. Division of Pediatric Critical Care Medicine, Department of Pediatrics Rutgers Robert Wood Johnson Medical School New Brunswick NJ

11. Section of Critical Care Medicine Department of Pediatrics Texas Children’s Hospital Houston TX

12. Division of Infectious Diseases, Department of Pediatrics New York University Grossman School of Medicine and Hassenfeld Children’s Hospital New York NY

13. Division of Pediatric Critical Care Medicine Department of Pediatrics Indiana University School of Medicine Riley Hospital for Children Indianapolis IN

14. Division of Pediatric Critical Care Medicine Department of Pediatrics University of Alabama at Birmingham Birmingham AL

15. Division of Pediatric Infectious Diseases Department of Pediatrics Vanderbilt University Medical Center Nashville TN

16. Division of Critical Care Medicine Department of Pediatrics Emory University School of Medicine Children’s Healthcare of Atlanta Atlanta GA

17. Division of Critical Care Medicine CHOC Children’s Hospital Orange CA

18. Division of Pediatric Critical Care University of Minnesota Masonic Children’s Hospital Minneapolis MN

19. Division of Pediatric Critical Care Department of Pediatrics Cooperman Barnabas Medical Center Livingston NJ

20. Department of Pediatrics Hackensack Meridian School of Medicine Hackensack NJ

21. Division of Critical Care Connecticut Children’s Medical Center Hartford CT

22. Division of Pediatric Critical Care Stead Family Department of Pediatrics University of Iowa Carver College of Medicine Iowa City IA

23. Division of Pediatric Critical Care Department of Pediatrics, Children’s Hospital and Medical Center Omaha NE

24. Division of Pediatric Critical Care Department of Pediatrics SUNY Downstate Health Sciences University Brooklyn NY

25. Divisions of Pediatric Infectious Diseases and Pediatric Critical Care Medicine Department of Pediatric and Adolescent Medicine, Mayo Clinic Rochester MN

26. Division of Pediatric Critical Care Department of Pediatrics University of Arizona Tucson AZ

27. Division of Pediatric Hospital Medicine Rainbow Babies and Children’s Hospital Cleveland OH

28. Division of Pediatric Critical Care St. Christopher’s Hospital for Children Philadelphia PA

29. Division of Pediatric Critical Care Department of Pediatrics Golisano Children’s Hospital University of Rochester Rochester NY

30. Departments of Anaesthesia and Pediatrics Harvard Medical School Boston MA

Abstract

Background Cardiac complications related to COVID‐19 in children and adolescents include ventricular dysfunction, myocarditis, coronary artery aneurysm, and bradyarrhythmias, but tachyarrhythmias are less understood. The goal of this study was to evaluate the frequency, characteristics, and outcomes of children and adolescents experiencing tachyarrhythmias while hospitalized for acute severe COVID‐19 or multisystem inflammatory syndrome in children. Methods and Results This study involved a case series of 63 patients with tachyarrhythmias reported in a public health surveillance registry of patients aged <21 years hospitalized from March 15, 2020, to December 31, 2021, at 63 US hospitals. Patients with tachyarrhythmias were compared with patients with severe COVID‐19–related complications without tachyarrhythmias. Tachyarrhythmias were reported in 22 of 1257 patients (1.8%) with acute COVID‐19 and 41 of 2343 (1.7%) patients with multisystem inflammatory syndrome in children. They included supraventricular tachycardia in 28 (44%), accelerated junctional rhythm in 9 (14%), and ventricular tachycardia in 38 (60%); >1 type was reported in 12 (19%). Registry patients with versus without tachyarrhythmia were older (median age, 15.4 [range, 10.4–17.4] versus 10.0 [range, 5.4–14.8] years) and had higher illness severity on hospital admission. Intervention for treatment of tachyarrhythmia was required in 37 (59%) patients and included antiarrhythmic medication (n=31, 49%), electrical cardioversion (n=11, 17%), cardiopulmonary resuscitation (n=8, 13%), and extracorporeal membrane oxygenation (n=9, 14%). Patients with tachyarrhythmias had longer hospital length of stay than those who did not, and 9 (14%) versus 77 (2%) died. Conclusions Tachyarrhythmias were a rare complication of acute severe COVID‐19 and multisystem inflammatory syndrome in children and adolescents and were associated with worse clinical outcomes, highlighting the importance of close monitoring, aggressive treatment, and postdischarge care.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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