Hi, my name is Bradley Clark. I'm the Director of Pediatric Electrophysiology at the Children's Hospital of Montefiore and Assistant Professor of Pediatrics at the Albert Einstein College of Medicine in the Bronx, New York. Today, I will be discussing pediatric electrophysiologic abnormalities presenting during the SARS-CoV-2 pandemic. EP abnormalities have been rare, either related to acute COVID-19 infection or multisystem inflammatory syndrome in children. Conduction abnormalities, including first-degree AV block, intermittent wanky block, both with and without baseline first-degree AV block, have been reported. At least one patient noted to have severely decreased left ventricular systolic function on presentation was noted to have complete AV block. The majority of pediatric patients with conduction abnormalities have either improved or resolved as their clinical course improved. Abnormal rhythms, such as idioventricular rhythm and sinus pauses, have also been documented. Ventricular tachycardia in the setting of prolonged QTC and ventricular tachyarrhythmias in the setting of severely decreased left ventricular systolic function while on ECMO support have been documented. The incidence of supraventricular tachyarrhythmias has been exceedingly rare, with only one known to have newly diagnosed SVT during the SARS-CoV-2 pandemic. Interestingly enough, pediatric patients have not been noted to have either atrial fibrillation or atrial flutter related to severe infection like their adult counterparts. Fevers associated with either COVID-19 or MIS-C have led to the diagnosis of Brugada syndrome in at least one patient. Interestingly enough, our center and another colleague in the United States have noted patients with significant QTC prolongation in the absence of QTC medications such as hydroxychloroquine or azithromycin. Our patient specifically had a QTC of 550 milliseconds during a period of bradycardia while not on any QTC medications. Weeks later, during follow-up, her QTC was noted to be in the borderline range of 460 milliseconds with a normal heart rate. Genetic testing was sent on this patient was negative for known genetic causes of long QTC syndrome. In summary, EP abnormalities such as conduction abnormalities, tachyarrhythmias, or arrhythmias syndromes have been rare during the SARS-CoV-2 pandemic and appear to be related to the severity of either COVID-19 or MIS-C infection. While early reports are encouraging that these abnormalities either improve or resolve based on clinical course improvement, surveillance with close follow-up, serial ECG, Holter or event monitor, and possibly additional genetic testing may be warranted. Thank you.

pediatric electrophysiologic abnormalities

SARS-CoV-2 pandemic

MIS-C

conduction abnormalities

ventricular tachycardia