In a recent study published in COVID, researchers explored the association between cardiac arrhythmias in children and coronavirus disease 2019 (COVID-19) infection.
Study: Cardiac Arrhythmias in Pediatric Age: Are They Triggered by SARS-CoV-2 Infection? Image Credit: Horacio Selva/Shutterstock
Background
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an extremely infectious disease. While extensive research has been conducted regarding the different aspects of the disease, research related to heart rhythm abnormalities in COVID-19-infected children is severely inadequate.
During SARS-CoV-2 pauci-symptomatic infection, a child and an adolescent with congenital heart disease (CHD) along with a pacemaker reported fascicular tachycardia and atrial flutter, respectively. The hemodynamic situation in the patients was stable. This is the first report of these tachyarrhythmias observed as a potential arrhythmic consequence during active paucisymptomatic SARS-CoV-2 infection.
The present study presented two COVID-19-associated arrhythmia cases reported between March 2020 and October 2021.
Presentation of case 1
A 10-month-old infant was admitted to the pediatric emergency room after 24 hours of agitation and inconsolable crying without the presence of fever, gastrointestinal, or respiratory problems. The infant's hemodynamic status was stable, and his blood pressure was typical for his age, but his heart rhythm exhibited tachycardia.
There were no cardiac pericardial rubs or murmurs detected. In addition, neither gastrointestinal nor respiratory pathological signals were identified. As per the echocardiogram (ECG), 220 beats per minute (bpm) of sustained ventricular tachycardia were detected. There was no evidence of congenital cardiac disease, coronary dilatation, or ventricular dysfunction on the ECG. The newborn also had no family history of rhythm abnormalities or sudden death.
The nasopharyngeal swab collected pre-admission was COVID-19-positive, although all other blood tests, including inflammatory testing and troponin, were negative. Furthermore, SARS-CoV-2 serology revealed a high immunoglobulin (Ig)-M antibody titer. Even though a few paroxysms of tachycardia were still detected in the subsequent four days, continuous intravenous amiodarone treatment was beneficial. The intravenous antiarrhythmic treatment was matched with oral somministration until amiodarone was administered entirely orally.
Overall, the arrhythmia was effectively managed, with no ventricular tachyarrhythmia recurrence reported. After five days, a second echocardiogram revealed normal systolic and diastolic biventricular function as well as normal coronary artery size. After 21 days of recovery employing oral antiarrhythmic medication with amiodarone, the patient was released with a stable sinus rhythm.
Presentation of case 2
A 16-year-old adolescent girl with a congenital heart disease atrioventricular septal defect (AVSD) that was surgically corrected along with a dual chamber pacemaker used for post-surgical total AV block experienced palpitations two days prior to admission in the pediatric emergency room.
At the commencement of symptoms, the device's remote control revealed atrial flutter onset two days prior. It was noted that this supraventricular tachyarrhythmia had never been recognized during prior periodic post-meridiem (PM) controls via telemedicine. The patient arrived at the emergency department with a stable hemodynamic condition and no symptoms, while the ECG revealed an atrial flutter 2:1 at a 120 bpm heart rate.
The nasopharyngeal swab obtained before patient admission was COVID-19-positive, although all other blood tests were negative. C-reactive protein (CRP), the other tests for inflammation, as well as troponin, tested negative. The ECG revealed no evidence of atrioventricular valve insufficiency, coronary dilation, or ventricular dysfunction. Anticoagulant medication with subcutaneous heparin was administered without taking into account an antiarrhythmic treatment.
After 15 days in quarantine, the patient's nasopharyngeal swab tested COVID-19-negative. The instrument remote control revealed the spontaneous restoration of sinus rhythm in accordance with the swab's negativization. In the following medium- and short-term follow-ups, the team identified no supraventricular arrhythmias.
Conclusion
The study findings highlighted that global literature revealing the association between COVID-19 and pediatric cardiac arrhythmias is expanding. These cases represent the first time these tachyarrhythmias have been documented as probable arrhythmic consequences with active paucisymptomatic SARS-CoV-2 infection. The self-resolving pattern of the AFL and the eventual fascicular tachycardia resolution was reported in concert with swab negativization. The researchers hypothesized whether the resolution of this tachycardia is associated with SARS-CoV-2 infection.
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