Incidence of arrhythmias and electrocardiographic abnormalities in symptomatic pediatric patients with PCR-positive SARS-CoV-2 infection, including drug-induced changes in the corrected QT interval

Heart Rhythm. 2020 Nov;17(11):1960-1966. doi: 10.1016/j.hrthm.2020.06.033. Epub 2020 Jul 1.

Abstract

Background: There is limited data regarding the electrophysiological abnormalities and arrhythmias in children with COVID-19, including those associated with treatment using potentially proarrhythmic hydroxychloroquine (HCQ) and azithromycin (AZN).

Objectives: To describe the electrophysiologic findings and arrhythmias associated with pediatric COVID-19 and its treatment.

Methods: A single-center retrospective chart review was undertaken and included all patients with (1) symptoms of COVID-19 and (2) PCR-positive nasopharyngeal swabs for SARS-CoV-2 who were placed on continuous telemetry for the duration of their hospitalization during March through May, 2020.

Results: Thirty-six patients were included in the study. Significant arrhythmias were found in 6 (nonsustained ventricular tachycardia in 5 and sustained atrial tachycardia in 1). All were self-resolving and half prompted prophylactic antiarrhythmic therapy. Patients with significant arrhythmias were likely to have noncardiac comorbidities (4/6), but these were not more common than in patients without arrhythmias (20/30, P = 1). The use of HCQ was associated with statistically significant QTc prolongation (413 ± 19 ms vs 425 ± 16 ms, P =.005). QTc was not statistically different in patients with and without arrhythmias (425 ± 15 ms vs 425 ± 15 ms, P = 1).

Conclusions: In pediatric patients with PCR-positive active COVID-19 infection, significant arrhythmias are infrequent, but are more common than expected in a general pediatric population. Comorbidities are not more common in patients with arrhythmias than in patients without arrhythmias. COVID-19 treatment using HCQ is associated with QTc prolongation but was not associated with arrhythmias in pediatric patients.

Keywords: Arrhythmias; COVID-19; Drug-induced prolonged QT; Hydroxychloroquine; Pediatric.

Publication types

  • Observational Study

MeSH terms

  • Anti-Infective Agents / administration & dosage
  • Anti-Infective Agents / adverse effects
  • Arrhythmias, Cardiac* / diagnosis
  • Arrhythmias, Cardiac* / epidemiology
  • Azithromycin* / administration & dosage
  • Azithromycin* / adverse effects
  • Betacoronavirus / isolation & purification
  • COVID-19
  • COVID-19 Testing
  • Child
  • Clinical Laboratory Techniques / methods
  • Coronavirus Infections* / diagnosis
  • Coronavirus Infections* / drug therapy
  • Coronavirus Infections* / epidemiology
  • Coronavirus Infections* / physiopathology
  • Electrocardiography* / methods
  • Electrocardiography* / statistics & numerical data
  • Female
  • Humans
  • Hydroxychloroquine* / administration & dosage
  • Hydroxychloroquine* / adverse effects
  • Incidence
  • Long QT Syndrome* / chemically induced
  • Long QT Syndrome* / diagnosis
  • Male
  • New York City / epidemiology
  • Outcome and Process Assessment, Health Care
  • Pandemics*
  • Pneumonia, Viral* / diagnosis
  • Pneumonia, Viral* / drug therapy
  • Pneumonia, Viral* / epidemiology
  • Pneumonia, Viral* / physiopathology
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2

Substances

  • Anti-Infective Agents
  • Hydroxychloroquine
  • Azithromycin