Plant Gayathri, Clegg Robin, Fruitman Deborah
Section of Critical Care, The Hospital for Sick Children, Toronto, Canada.
Department of Paediatrics, Alberta Children's Hospital, Calgary, Canada.
Pediatr Cardiol. 2025 Sep 25. doi: 10.1007/s00246-025-04017-x.
Myocarditis is an important cause of mortality, and particularly sudden death, in children. Arrhythmias, particularly tachyarrhythmias, are a known clinical sequelae of myocarditis. Bradyarrhythmias and conduction disease in pediatric myocarditis are a less common, but potentially critical complication of myocarditis, which may be associated with increased morbidity and mortality. Pediatric myocarditis with effects on atrioventricular conduction and ventricular conduction represents an underexplored and clinically significant field. We conducted a systematic review of the published literature and present two cases of significant conduction disease. Literature searches were performed as per PRISMA guidelines in Medline, EMBASE, Web of Science, and Cochrane Systematic Reviews. We analyzed 53 articles and identified 175 published cases of atrioventricular (AV) conduction disease and bradyarrhythmias in pediatric myocarditis. Diagnostic approaches were varied among the studies, with heterogeneity in both serum investigations, cardiac imaging, and management of the conduction issues. There were 91 cases of complete heart block, 53 cases of first-degree heart block, 11 cases of second-degree heart block, and 10 reported cases of clinically significant sinus bradycardia. Of the 175 reported cases, 31 required temporary pacing, with 10 having a pacemaker implanted, and the remaining were treated with medical therapy alone and did not require pacemaker placement. In this review, there were 13 deaths among the 175 reported cases, all of whom had complete heart block. AV conduction disease in pediatric myocarditis, although less common, can be clinically significant and have severe outcomes. The variation in presentation, treatment, outcome, and diversity in pathogens warrants further study in order to improve our understanding of this potential complication of myocarditis.
心肌炎是儿童死亡尤其是猝死的重要原因。心律失常，尤其是快速性心律失常，是已知的心肌炎临床后遗症。缓慢性心律失常和传导疾病在小儿心肌炎中虽较少见，但可能是心肌炎的关键并发症，可能与发病率和死亡率增加有关。影响房室传导和心室传导的小儿心肌炎是一个尚未充分探索但具有临床重要性的领域。我们对已发表的文献进行了系统综述，并报告两例严重传导疾病的病例。按照PRISMA指南在Medline、EMBASE、科学网和Cochrane系统评价中进行文献检索。我们分析了53篇文章，确定了175例已发表的小儿心肌炎房室传导疾病和缓慢性心律失常病例。各研究的诊断方法各不相同，血清检查、心脏成像以及传导问题的管理均存在异质性。有91例完全性心脏传导阻滞、53例一度心脏传导阻滞、11例二度心脏传导阻滞以及10例报告的具有临床意义的窦性心动过缓病例。在175例报告病例中，31例需要临时起搏，10例植入了起搏器，其余仅接受药物治疗，无需植入起搏器。在本综述中，175例报告病例中有13例死亡，均为完全性心脏传导阻滞。小儿心肌炎中的房室传导疾病虽然少见，但可能具有临床重要性并产生严重后果。临床表现、治疗、结局的差异以及病原体多样性值得进一步研究，以增进我们对心肌炎这一潜在并发症的理解。
