Assessing ECG Findings in Pediatric COVID-19 Patients: A Comprehensive Analysis

Introduction: COVID-19 can be associated with varying degrees of cardiac involvement in children, such that myocardial damage can be caused directly by the COVID-19 virus itself or systemic inflammation caused by the infection. The present study was conducted with the aim of evaluating ECG findings in children with COVID-19. Methods: This is a prospective cross-sectional study that was conducted by census method on 764 children with COVID-19 in hospitals related to Mashhad University of Medical Sciences in 2022. The data were extracted using a checklist including clinical information and medical records of the patients and analyzed using descriptive and statistical tests. Results: 764 children with COVID-19 were examined, of which 385 (51%) were male. The studied patients included MISC (25.9%), Kawasaki-like disease (0.3%), pulmonary (12.7%), and gastrointestinal (2%) involvements. More than half of the patients (58%, 444 patients) showed changes in echocardiography findings, including mitral valve insufficiency, dilation of one or more cardiac chambers, and pericardial effusion. 98.8% of patients had NAX. AVB grade I was found in 26 patients (3.4%). Abnormal ST-T segments were observed in 25 patients (3.3%). The prevalence rate of S wave fragmentation was 2.8% (21), and fragmented R waves were found in 13 patients (1.7%). Discussion: Patients hospitalized in the intensive care unit (ICU) had a higher amount of disorder for each parameter change. Additionally, a significant association was found between the higher occurrence of AV node block and arrhythmia with clinical status (p<0.05), with the same higher rate in patients kept in the ICU. Conclusion: ECG findings can be used to predict the presence or absence of myocardial involvement as well as its severity. Furthermore, patients with changes in ST-T fQRS and PR interval are more likely to experience cardiac involvement, which could result in a poorer prognosis.