Brugada Pattern in a Child with Severe SARS-CoV-2 Related Multisystem Inflammatory Syndrome

Figures

• 

  Figure 1. First electrocardiogram recorded on admission showing Brugada type 1 pattern in V1 and V2. It is characterized by a coved ST-segment elevation displaying J-point amplitude or ST-segment elevation ≥2 mm, followed by a negative T wave in more than one right precordial leads (V1 to V3).

• 

  Figure 2. Pedigree showing the patient’s (IV 1) family history. A cousin of the patient’s father died of sudden cardiac death at the age of 35 (III 1).

• 

  Figure 3. Progressive improvement of inflammation and cardiac markers and ECG normalization during treatment with intravenous immunoglobulins and methylprednisolone boluses. Troponin on admission was 23 ng/L (normal reference value for age < 14) and normalized at the 2nd day of treatment.

• 

  Figure 4. Atrial ectopic tachycardia (AET) at heart rate of 120 beats/min recorded on day 2 of hospitalization. The diagnosis is based on the presence of a regular narrow QRS complex tachycardia with an abnormal P-wave morphology originating from an ectopic focus. As shown in the magnification insert, the P-wave is not visible because it is morphologically different from the sinus one and it is fused with the preceding T-wave.

• 

  Figure 5. Sinus rhythm with first-degree atrioventricular block (AVB) in progress of MIS-C associated with coronavirus disease 2019 (COVID-19). First-degree AVB is a delay, without interruption, in conduction from atria to ventricles resulting in an increased PR interval greater than 200 ms.

• 

  Figure 6. Complete ECG normalization after 7 days of MIS-C treatment according to current guidelines.