CarCardiac Arrhythmias in Patients Presenting with Myocarditis/Myopericarditis-A Single Center Retrospective Studydiac Arrhythmias in Patients Presenting with Myocarditis/Myopericarditis-A Single Center Retrospective Study
Abstract
Objective: Isolated myocarditis/myopericarditis, characterized by involvement and inflammation of the heart muscle and pericardium, is mostly seen after a viral infection. Different types of cardiac arrhythmias may occur during myocarditis/myopericarditis in children. Studies on this subject in children are rare. We aimed to present the arrhythmias seen in patients with myocarditis/myopericarditis, and the treatments. Another aim was to evaluate the effect of arrhythmias on the course of the disease and establish risk factors.
Material and Methods: The files of 79 patients who were followed up in our hospital with the diagnosis of myocarditis/myopericarditis between September 2021 and March 2023 were reviewed retrospectively.
Results: The ages of the patients ranged from 2 months to 18 years. 44 patients (55.6%) were male; 35 patients (44.3%) were girls. Uniform ventricular extrasystoles at baseline electrocardiography were observed in 8/79 (10.1%) patients. One patient had atrial tachycardia, one had atrial fibrillation, one had sustained ventricular tachycardia, and three patients had supraventricular tachycardia. In the 24 Hour-Holter monitorization of the remaining patients, non-sustained ventricular tachycardia attacks and polymorphic ventricular extrasystoles were observed in 5/79 (6.3%) patients, and uniform ventricular extrasystole was observed in 11/79 (13.9%) patients. In total, 30/79 (37.9%) of the patients had arrhythmia. Anti-arrhythmic therapy was started in patients with high risk. Patients with good general condition, in whom had only uniform ventricular extrasystole and no problem in the control holter monitoring,were followed up clinically without any problems. There was no significant difference in terms of length of hospital stay. Arrhythmia recurred in two patients.
Conclusion: The first presentation of myocarditis/myopericarditis might be with arrhythmias. Patients should be monitored for rhythm problems. 24-hour Holter monitoring is important in detecting arrhythmias. Because of the risk of recurrence of arrhythmia after the acute period, patients should be followed up.
References
- Putschoegl A, Auerbach S. Diagnosis, Evaluation, and treatment of myocarditis in children. Pediatr Clin North Am. 2020;67(5):855-74.
- Wu MH, Wu ET, Wang CC, Lu F, Chen HC, Kao FY, et al. Contemporary postnatal incidence of acquiring acute myocarditis by age 15 years and the outcomes from a nationwide birth cohort. Pediatr Crit Care Med. 2017;18(12):1153-8.
- Bejiqi R, Retkoceri R, Maloku A, Mustafa A, Bejiqi H, Bejiqi R. The diagnostic and clinical approach to pediatric myocarditis: a review of the current literature. Open Access Maced J Med Sci. 2019;7(1):162-73.
- Nakashima H, Honda Y, Katayama T. Serial electrocardiographic findings in acute myocarditis. Intern Med. 1994;33(11):659-66.
- Miyake CY, Teele SA, Chen L, Motonaga KS, Dubin AM, Balasubramanian S, et al. In-hospital arrhythmia development and outcomes in pediatric patients with acute myocarditis. The American journal of cardiology. 2014;113(3):535-40.
- Peretto G, Sala S, Rizzo S, De Luca G, Campochiaro C, Sartorelli S, et al. Arrhythmias in myocarditis: State of the art. Heart Rhythm. 2019;16(5):793-801.
- Batra AS, Epstein D, Silka MJ. The clinical course of acquired complete heart block in children with acute myocarditis. Pediatr Cardiol. 2003;24(5):495-7.
- Peretto G, Sala S, Rizzo S, De Luca G, Campochiaro C, Sartorelli S, et al. Arrhythmias in myocarditis: state of the art. Heart Rhythm. 2019;16(5):793-801.
- Peretto G, Sala S, Rizzo S, Palmisano A, Esposito A, De Cobelli F, et al. Ventricular arrhythmias in myocarditis: characterization and relationships with myocardial inflammation. J Am Coll Cardiol. 2020;75(9):1046-57.
- Vio R, Zorzi A, Corrado D. Myocarditis in the Athlete: Arrhythmogenic substrates, clinical manifestations, management, and eligibility decisions. J Cardiovasc Transl Res. 2020;13(3):284-95.
- Weber MA, Ashworth MT, Risdon RA, Malone M, Burch M, Sebire NJ. Clinicopathological features of paediatric deaths due to myocarditis: an autopsy series. Arch Dis Child. 2008;93(7):594-8.
- Cooper LT, Jr. Ventricular arrhythmias and sudden cardiac death in lymphocytic myocarditis. J Am Coll Cardiol. 2020;75(9):1058-60.
- Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The task force for the diagnosis and management of pericardial diseases of the European Society of Cardiology (ESC) endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2015;36(42):2921-64.
- Law YM, Lal AK, Chen S, Čiháková D, Cooper LT, Jr., Deshpande S, et al. Diagnosis and management of myocarditis in children: a scientific statement from the American Heart Association. Circulation. 2021;144(6):e123-e35.
- Butts RJ, Boyle GJ, Deshpande SR, Gambetta K, Knecht KR, Prada-Ruiz CA, et al. Characteristics of clinically diagnosed pediatric myocarditis in a contemporary multi-center cohort. Pediatr Cardiol. 2017;38(6):1175-82.
- Baman TS, Lange DC, Ilg KJ, Gupta SK, Liu TY, Alguire C, et al. Relationship between burden of premature ventricular complexes and left ventricular function. Heart Rhythm. 2010;7(7):865-9.
- Ali-Ahmed F, Dalgaard F, Al-Khatib SM. Sudden cardiac death in patients with myocarditis: Evaluation, risk stratification, and management. Am Heart J. 2020;220:29-40.
- Kim J, Cho MJ. Acute Myocarditis in Children: a 10-year Nationwide Study (2007-2016) based on the Health Insurance Review and Assessment Service Database in Korea. Korean Circ J. 2020;50(11):1013-22.
- Rasal G, Deshpande M, Mumtaz Z, Phadke M, Mahajan A, Nathani P, et al. Arrhythmia spectrum and outcome in children with myocarditis. Ann Pediatr Cardiol. 2021;14(3):366-71.
- Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology. 2018;72(14):e91-e220.
MİYOKARDİT/MİYOPERİKARDİT İLE BAŞVURAN HASTALARDA KARDİYAK ARİTMİLER-TEK MERKEZLİ RETROSPEKTİF BİR ÇALIŞMA
Abstract
Amaç: Kalp kasının ve perikardın tutulumu ve inflamasyonu ile karakterize izole miyokardit/miyoperikardit, çoğunlukla viral bir enfeksiyon sonrası görülür. Çocuklarda miyokardit/miyoperikardit sırasında çeşitli kardiyak aritmiler görülebilir. Literatürde çocuklarda bu konu ile ilgili çalışmalar nispeten azdır. Bu çalışma ile tek bir merkezde takip edilen miyokardit/miyoperikarditli olgularda görülen aritmileri ve uyguladığımız tedavileri sunmayı amaçladık. Bir diğer hedefimiz aritmilerin hastalığın seyrine etkisini ve aritmiye yol açabilecek risk faktörlerini değerlendirmekti.
Gereç ve Yöntemler: Eylül 2021-Mart 2023 tarihleri arasında, hastanemizde miyokardit/ miyoperikardit tanısı ile takip edilen 79 olgunun dosyaları geriye dönük olarak incelendi.
Bulgular: Hastaların yaşları 2 ay-18 yıl arasında değişmekteydi. Hastaların 44’ü (%55.6) erkek, 35’i (%44.3) kız idi. Elektrokardiyografide 8/79 (%10.1) hastada bazalde uniformik ventriküler ekstrasistoller görüldü. Bir hastanın başvurusunda atriyal taşikardisi, birinde atriyal fibrilasyon, birinde sürekli ventriküler taşikardi, üç hastada ise supraventriküler taşikardi mevcuttu. Kalan hastaların holter incelemelerinde 5/79 (6.3%) hastada sürekli olmayan ventriküler taşikardi atağı ve farklı şekilllerde ventriküler ekstrasistoller izlendi, 11/79 (%13.9) hastada ise uniformik ventriküler ekstrasistol görüldü. Totalde hastaların 30/79‘unda (%37.9) aritmi görüldü. Riskli hastalara antiaritmik tedavi başlandı. Genel durumu iyi olan, sadece uniformik ventriküler ekstrasistolleri olan ve kontrol holterde sorun olmayan hastalar klinik olarak sorunsuz takip edildiler. Aritmisi olanlarla olmayanlar arasında, hastaların yatış süresi açısından belirgin bir farklılık gözlenmedi. Akut dönem sonrası iki hastada aritmi tekrarladı.
Sonuç: Miyokardit/miyoperikarditin ilk başvurusu aritmilerle olabileceği gibi, klinik seyirde sonradan karşımıza çıkabilir ve hastalar ritm açısından monitorize edilmelidir. 24 saat Holter monitorizayonu aritmileri yakalamada önemlidir. Akut dönem sonrası da aritminin tekrarlama riski nedeniyle hastalar takip edilmelidir.
Supporting Institution
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References
- Putschoegl A, Auerbach S. Diagnosis, Evaluation, and treatment of myocarditis in children. Pediatr Clin North Am. 2020;67(5):855-74.
- Wu MH, Wu ET, Wang CC, Lu F, Chen HC, Kao FY, et al. Contemporary postnatal incidence of acquiring acute myocarditis by age 15 years and the outcomes from a nationwide birth cohort. Pediatr Crit Care Med. 2017;18(12):1153-8.
- Bejiqi R, Retkoceri R, Maloku A, Mustafa A, Bejiqi H, Bejiqi R. The diagnostic and clinical approach to pediatric myocarditis: a review of the current literature. Open Access Maced J Med Sci. 2019;7(1):162-73.
- Nakashima H, Honda Y, Katayama T. Serial electrocardiographic findings in acute myocarditis. Intern Med. 1994;33(11):659-66.
- Miyake CY, Teele SA, Chen L, Motonaga KS, Dubin AM, Balasubramanian S, et al. In-hospital arrhythmia development and outcomes in pediatric patients with acute myocarditis. The American journal of cardiology. 2014;113(3):535-40.
- Peretto G, Sala S, Rizzo S, De Luca G, Campochiaro C, Sartorelli S, et al. Arrhythmias in myocarditis: State of the art. Heart Rhythm. 2019;16(5):793-801.
- Batra AS, Epstein D, Silka MJ. The clinical course of acquired complete heart block in children with acute myocarditis. Pediatr Cardiol. 2003;24(5):495-7.
- Peretto G, Sala S, Rizzo S, De Luca G, Campochiaro C, Sartorelli S, et al. Arrhythmias in myocarditis: state of the art. Heart Rhythm. 2019;16(5):793-801.
- Peretto G, Sala S, Rizzo S, Palmisano A, Esposito A, De Cobelli F, et al. Ventricular arrhythmias in myocarditis: characterization and relationships with myocardial inflammation. J Am Coll Cardiol. 2020;75(9):1046-57.
- Vio R, Zorzi A, Corrado D. Myocarditis in the Athlete: Arrhythmogenic substrates, clinical manifestations, management, and eligibility decisions. J Cardiovasc Transl Res. 2020;13(3):284-95.
- Weber MA, Ashworth MT, Risdon RA, Malone M, Burch M, Sebire NJ. Clinicopathological features of paediatric deaths due to myocarditis: an autopsy series. Arch Dis Child. 2008;93(7):594-8.
- Cooper LT, Jr. Ventricular arrhythmias and sudden cardiac death in lymphocytic myocarditis. J Am Coll Cardiol. 2020;75(9):1058-60.
- Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The task force for the diagnosis and management of pericardial diseases of the European Society of Cardiology (ESC) endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2015;36(42):2921-64.
- Law YM, Lal AK, Chen S, Čiháková D, Cooper LT, Jr., Deshpande S, et al. Diagnosis and management of myocarditis in children: a scientific statement from the American Heart Association. Circulation. 2021;144(6):e123-e35.
- Butts RJ, Boyle GJ, Deshpande SR, Gambetta K, Knecht KR, Prada-Ruiz CA, et al. Characteristics of clinically diagnosed pediatric myocarditis in a contemporary multi-center cohort. Pediatr Cardiol. 2017;38(6):1175-82.
- Baman TS, Lange DC, Ilg KJ, Gupta SK, Liu TY, Alguire C, et al. Relationship between burden of premature ventricular complexes and left ventricular function. Heart Rhythm. 2010;7(7):865-9.
- Ali-Ahmed F, Dalgaard F, Al-Khatib SM. Sudden cardiac death in patients with myocarditis: Evaluation, risk stratification, and management. Am Heart J. 2020;220:29-40.
- Kim J, Cho MJ. Acute Myocarditis in Children: a 10-year Nationwide Study (2007-2016) based on the Health Insurance Review and Assessment Service Database in Korea. Korean Circ J. 2020;50(11):1013-22.
- Rasal G, Deshpande M, Mumtaz Z, Phadke M, Mahajan A, Nathani P, et al. Arrhythmia spectrum and outcome in children with myocarditis. Ann Pediatr Cardiol. 2021;14(3):366-71.
- Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology. 2018;72(14):e91-e220.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Services and Systems (Other) |
| Journal Section | Özgün Araştırma |
| Authors | |
| Publication Date | August 31, 2023 |
| Submission Date | August 2, 2023 |
| Published in Issue | Year 2023 Volume: 25 Issue: 2 |
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