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

• Authors: Audrey Dionne, Harvard Medical School; Kevin G Friedman, Harvard Medical School; Cameron C Young, Children's Hospital Boston; Margaret M Newhams, Children's Hospital Boston; Suden Kucukak, Children's Hospital Boston; Ashley M Jackson, Centers for Disease Control and Prevention; Julie C Fitzgerald, University of Pennsylvania Perelman School of Medicine; Laura S Smallcomb, Medical University of South Carolina; Sabrina Heidemann, Central Michigan University; Gwenn E McLaughlin, University of Miami Leonard M. Miller School of Medicine; Katherine Irby, Arkansas Children's Hospital; Tamara T Bradford, LSUHSC School of Medicine; Steven M Horwitz, Rutgers Robert Wood Johnson Medical School; Laura L Loftis, Texas Children's Hospital Houston; Vijaya L Soma, NYU Grossman School of Medicine; Courtney M Rowan, Indiana University School of Medicine; Michele Kong, The University of Alabama at Birmingham; Natasha B Halasa, Vanderbilt University Medical Center; Keiko Tarquinio, Emory University; Adam J Schwarz, CHOC Children‘s UC Irvine School of Medicine; Janet R Hume, University of Minnesota Twin Cities; Shira J Gertz, Cooperman Barnabas Medical Center; Katharine N Clouser, Hackensack Meridian School of Medicine; Christopher L Carroll, Connecticut Children's Medical Center; Kari Wellnitz, University of Iowa Carver College of Medicine; Melissa L Cullimore, Children's Hospital and Medical Center; Sule Doymaz, SUNY Downstate Health Sciences University; Emily R Levy, Mayo Clinic; Katri V Typpo, The University of Arizona; Amanda N Lansell, University Hospitals Rainbow Babies & Children's Hospital; Andrew D Butler, St. Christopher's Hospital for Children Philadelphia; Joseph D Kuebler, Golisano Children‘s Hospital at Strong; Laura D Zambrano, Centers for Disease Control and Prevention; Angela Campbell, Emory University; Manish M Patel, Centers for Disease Control and Prevention; Adrienne G Randolph, Children's Hospital Boston; Jane W Newburger, Harvard Medical School
• Journal Title: Journal of the American Heart Association
• Volume: Volume 11, Number 20
• Publisher: Wiley. | 2022-10-18, Pages e025915-e025915
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1161/JAHA.122.025915
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: COVID‐19; multisystem inflammatory syndrome in children (MIS‐C); tachyarrhythmia; Child; Humans; Adolescent; COVID-19; Aftercare; Patient Discharge; Hospitalization; Tachycardia, Supraventricular; Arrhythmias, Cardiac

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.