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Impact of ventricular arrhythmias on outcomes in children with myocarditis

European Journal of Pediatrics volume 179, pages 1779–1786 (2020)Cite this article

Abstract

Children affected with acute myocarditis may progress rapidly into profound ventricular dysfunction and ventricular arrhythmias. The objective of this study is to assess the impact of ventricular arrhythmias on in-hospital mortality and the use of mechanical circulatory support in patients with myocarditis. Pediatric patients (age 0–18 years) admitted with myocarditis were identified from the National Inpatient Sample dataset for the years 2002–2015. A total of 12,489 patients with myocarditis were identified. Of them, 1627 patients were with ventricular arrhythmias and 10,862 patients without ventricular arrhythmias. Mortality was higher in those with ventricular arrhythmias (19.5% vs. 2.8%, OR = 8.47; 95% CI 7.16–10.04; p < 0.001). The median length of stay and the median cost of hospitalization were higher in the ventricular arrhythmias group (9 days vs. 4 days, p < 0.001 and $121,826 vs. $37,658, p < 0.001, respectively). There was a substantial increase in the utilization of extracorporeal membrane oxygenation (ECMO) in patients with ventricular arrhythmias (25.4% vs. 2.7%, OR = 12.40; 95% CI 10.55–14.57; p < 0.001). The use of ventricular assist devices (VADs) was higher in patients with ventricular arrhythmias (4.5% vs. 1.3%, OR = 3.76; 95% CI 2.82–5.01; p < 0.001). An improvement in discharge survival was observed over the years of study in both VA and non-VA groups; associated with this decline in mortality, there was a rising trend of ECMO utilization.

Conclusion: Development of ventricular arrhythmia in children with myocarditis is a strong predictor for mortality and ECMO utilization.

What is Known:

• The clinical presentation of pediatric myocarditis varies from no symptoms of myocardial dysfunction to a rapidly progressing severe congestive heart failure.

• Little is known about the predictors of mortality in children with suspected myocarditis.

What is New:

• Development of ventricular arrhythmia in children with myocarditis is a strong predictor for mortality and ECMO utilization.

• Improvement in discharge survival was observed over the years of study; associated with this decline in mortality, there was a rising trend of ECMO utilization.

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Abbreviations

ECMO:

Extracorporeal membrane oxygenation

NIS:

National inpatient sample

HCUP:

Healthcare Cost and Utilization Project

AHRQ:

Agency for Healthcare Research and Quality

ICD-9-CM:

International Classification of Disease, Ninth Revision, Clinical Modification

LOS:

Length of stay

OR:

Odds ratio

CI:

Confidence interval

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Author information

Authors and Affiliations

  1. Department of Pediatrics, Michigan State University/Sparrow Health System, Lansing, MI, USA

    Hasan F. Othman

  2. Department of Pediatric Cardiology, Children’s of Alabama, Birmingham, AL, USA

    Jonathan Byrnes

  3. Department of Neonatology, Cleveland Clinic Children’s Hospital, Cleveland, OH, USA

    Esraa Elsamny

  4. Department of Pediatric Critical Care, Cleveland Clinic Children’s, 9500 Euclid Ave. M14, Cleveland, OH, 44195, USA

    Mohammed Hamzah

Authors
  1. Hasan F. Othman
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  2. Jonathan Byrnes
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  3. Esraa Elsamny
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  4. Mohammed Hamzah
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Contributions

Dr. Othman carried out the initial analyses, drafted, reviewed, and revised the manuscript.

Dr. Byrnes drafted, reviewed, and revised the manuscript.

Dr. Elsamny drafted, reviewed, and revised the manuscript.

Dr. Hamzah conceptualized and designed the study, drafted, and critically reviewed the manuscript for important intellectual content.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Mohammed Hamzah.

Ethics declarations

The study was granted an exempt status from the Cleveland Clinic Institutional Review Board (May 16, 2019).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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Communicated by Piet Leroy

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Othman, H.F., Byrnes, J., Elsamny, E. et al. Impact of ventricular arrhythmias on outcomes in children with myocarditis. Eur J Pediatr 179, 1779–1786 (2020). https://doi.org/10.1007/s00431-020-03687-4

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  • DOI: https://doi.org/10.1007/s00431-020-03687-4

Keywords

  • Myocarditis
  • Ventricular arrhythmia
  • Mortality
  • ECMO
  • Heart transplant