Abstract PCCLB-65: Reappraisal of electrocardiographic changes in pediatric patients with acute myocarditis

Abstract

Purpose: The literature on parameters predictive of fulminant myocarditis is limited, especially in pediatric patients. ECG is an important part of the integrated synopsis for diagnosis of myocarditis. The purpose of this study was to evaluate the prognostic significance of electrocardiographic (ECG) changes in pediatric patients with acute myocarditis Methods: This study recruited 21 children with suspected myocarditis, who were treated in acute stage at the department of pediatrics, Kaohsiung Veterans General Hospital, Taiwan. Medical records was reviewed for age, sex, presenting symptoms, ECG findings, treatment, and clinical course. The ECG was analysed for rhythm, conduction times, signs of hypertrophy, and repolarization abnormalities Results: ECG analysis was undertaken in 21 pediatric patients (M/F 15/6, 11.0 ±5.7 years). In 12 patients with the predominant symptom of chest pain, sinus rhythm, normal QRS, and repolarization abnormalities were the prevailing ECG features at the time of admission. Repolarization abnormalities improved gradually under symptomatic treatment. They were discharged with normal ECG and LV function. In 3 patients with the predominant symptom of tachycardia, sinus rhythm, normal QRS, and repolarization abnormalities were the prevailing ECG features on admission, which improved on discharge. In the remaining 6 patients with acute fulminant myocarditis, sinus tachycardia, wide QRS, VPC, VT, LBBB, AV block and repolarization abnormalities were the prevailing ECG features at the time of admission. Severe hypotension required intravenous inotropic support. ECMO was performed in two patients. Of the 21 patients, 17 were discharged with normal EKG, 2 were discharged with RBBB, and 2 children died. Conclusions: ECG changes varied greatly in pediatric patients with acute myocarditis. Repolarization abnormalities in stable patients generally improved after symptomatic treatment. In patients with acute fulminant myocarditis, ECG changes may be early signs of severe LV dysfunction and an indication for aggressive inotropic support, even ECMO. Most patients with resolved myocarditis had normal EKG, but RBBB may persist in some patients.