In-hospital arrhythmia development and outcomes in pediatric patients with acute myocarditis

Christina Y. Miyake, Sarah A. Teele, Liyuan Chen, Kara S. Motonaga, Anne M. Dubin, Sowmya Balasubramanian, Raymond Balise, David N. Rosenthal, Mark E. Alexander, Edward P. Walsh, Douglas Y. Mah

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Abstract

Cardiac arrhythmias are a complication of myocarditis. There are no large studies of in-hospital arrhythmia development and outcomes in pediatric patients with acute myocarditis. This was a retrospective 2-center review of patients ≤21 years hospitalized with acute myocarditis from 1996 to 2012. Fulminant myocarditis was defined as the need for inotropic support within 24 hours of presentation. Acute arrhythmias occurred at presentation and subacute after admission. Eighty-five patients (59% men) presented at a median age of 10 years (1 day to 18 years). Arrhythmias occurred in 38 patients (45%): 16 acute, 12 subacute, and 9 acute and subacute (1 onset unknown). Arrhythmias were associated with low voltages on the electrocardiogram (14 of 34, 41% vs 6 of 47, 13%; odds ratio [OR] 4.78, 95% confidence interval [CI] 1.60 to 14.31) and worse outcome (mechanical support, orthotopic heart transplant, or death; OR 7.59, 95% CI 2.61 to 22.07) but were not statistically significantly associated with a fulminant course, ST changes, initial myocardial function, lactate, creatinine level, C-reactive protein and/or erythrocyte sedimentation rate, or troponin I level, after adjusting for multiple comparisons. Subacute arrhythmias were associated with preceding ST changes (10 of 15, 67% vs 15 of 59, 25%, OR 5.87, 95% CI 1.73 to 19.93). All patients surviving to discharge had arrhythmia resolution or control before discharge (10 on antiarrhythmic), with 1 exception (patient with complete heart block requiring a pacemaker). At 1-year follow-up, there were 3 recurrences of ventricular arrhythmias, but no arrhythmia-related mortality. In conclusion, arrhythmias are common in pediatric patients with myocarditis, occurring in nearly 1/2 of all hospitalized children and are associated with a worse outcome. Early identification of subacute arrhythmias using electrocardiographic changes may help management. A majority of patients do not require continued postdischarge arrhythmia treatment.

Original languageEnglish (US)
Pages (from-to)535-540
Number of pages6
JournalAmerican Journal of Cardiology
Volume113
Issue number3
DOIs
StatePublished - Feb 1 2014
Externally publishedYes

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Myocarditis
Cardiac Arrhythmias
Pediatrics
Odds Ratio
Confidence Intervals
Hospitalized Child
Heart Block
Troponin I
Blood Sedimentation
C-Reactive Protein
Lactic Acid
Creatinine
Electrocardiography
Transplants

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Miyake, C. Y., Teele, S. A., Chen, L., Motonaga, K. S., Dubin, A. M., Balasubramanian, S., ... Mah, D. Y. (2014). In-hospital arrhythmia development and outcomes in pediatric patients with acute myocarditis. American Journal of Cardiology, 113(3), 535-540. https://doi.org/10.1016/j.amjcard.2013.10.021

In-hospital arrhythmia development and outcomes in pediatric patients with acute myocarditis. / Miyake, Christina Y.; Teele, Sarah A.; Chen, Liyuan; Motonaga, Kara S.; Dubin, Anne M.; Balasubramanian, Sowmya; Balise, Raymond; Rosenthal, David N.; Alexander, Mark E.; Walsh, Edward P.; Mah, Douglas Y.

In: American Journal of Cardiology, Vol. 113, No. 3, 01.02.2014, p. 535-540.

Research output: Contribution to journalArticle

Miyake, CY, Teele, SA, Chen, L, Motonaga, KS, Dubin, AM, Balasubramanian, S, Balise, R, Rosenthal, DN, Alexander, ME, Walsh, EP & Mah, DY 2014, 'In-hospital arrhythmia development and outcomes in pediatric patients with acute myocarditis', American Journal of Cardiology, vol. 113, no. 3, pp. 535-540. https://doi.org/10.1016/j.amjcard.2013.10.021
Miyake, Christina Y. ; Teele, Sarah A. ; Chen, Liyuan ; Motonaga, Kara S. ; Dubin, Anne M. ; Balasubramanian, Sowmya ; Balise, Raymond ; Rosenthal, David N. ; Alexander, Mark E. ; Walsh, Edward P. ; Mah, Douglas Y. / In-hospital arrhythmia development and outcomes in pediatric patients with acute myocarditis. In: American Journal of Cardiology. 2014 ; Vol. 113, No. 3. pp. 535-540.
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abstract = "Cardiac arrhythmias are a complication of myocarditis. There are no large studies of in-hospital arrhythmia development and outcomes in pediatric patients with acute myocarditis. This was a retrospective 2-center review of patients ≤21 years hospitalized with acute myocarditis from 1996 to 2012. Fulminant myocarditis was defined as the need for inotropic support within 24 hours of presentation. Acute arrhythmias occurred at presentation and subacute after admission. Eighty-five patients (59{\%} men) presented at a median age of 10 years (1 day to 18 years). Arrhythmias occurred in 38 patients (45{\%}): 16 acute, 12 subacute, and 9 acute and subacute (1 onset unknown). Arrhythmias were associated with low voltages on the electrocardiogram (14 of 34, 41{\%} vs 6 of 47, 13{\%}; odds ratio [OR] 4.78, 95{\%} confidence interval [CI] 1.60 to 14.31) and worse outcome (mechanical support, orthotopic heart transplant, or death; OR 7.59, 95{\%} CI 2.61 to 22.07) but were not statistically significantly associated with a fulminant course, ST changes, initial myocardial function, lactate, creatinine level, C-reactive protein and/or erythrocyte sedimentation rate, or troponin I level, after adjusting for multiple comparisons. Subacute arrhythmias were associated with preceding ST changes (10 of 15, 67{\%} vs 15 of 59, 25{\%}, OR 5.87, 95{\%} CI 1.73 to 19.93). All patients surviving to discharge had arrhythmia resolution or control before discharge (10 on antiarrhythmic), with 1 exception (patient with complete heart block requiring a pacemaker). At 1-year follow-up, there were 3 recurrences of ventricular arrhythmias, but no arrhythmia-related mortality. In conclusion, arrhythmias are common in pediatric patients with myocarditis, occurring in nearly 1/2 of all hospitalized children and are associated with a worse outcome. Early identification of subacute arrhythmias using electrocardiographic changes may help management. A majority of patients do not require continued postdischarge arrhythmia treatment.",
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