# Electrocardiography in Children Hospitalized for COVID-19 and Not Suffering from Multisystem Inflammatory Syndrome in Children (MIS-C): An Observational Study

## TL;DR

This study finds that children hospitalized for COVID-19 without MIS-C rarely show heart issues, suggesting routine heart tests may not be needed.

## Contribution

The study provides new insights into cardiac involvement in children with COVID-19, excluding MIS-C, using electrocardiographic data.

## Key findings

- No arrhythmias or electrocardiographic abnormalities were detected in hospitalized children with COVID-19.
- Children under 2 years had higher troponin and D-dimer levels, but within normal age-specific ranges.
- Routine ECG evaluation is not necessary for children with COVID-19 who lack cardiac symptoms or signs.

## Abstract

The risk of cardiac involvement with electrophysiological abnormalities during COVID-19 infection has been reported in adults but remains poorly studied in children. Our aim was to determine the frequency of cardiac involvement and the necessity of routine cardiac evaluation in children hospitalized for COVID-19. This observational study included 127 children, with a median (IQR) age of 2 (0.83–6.0) years, who were hospitalized for COVID-19 between 1 January 2021 and 31 August 2022, 62 (48.8%) of whom were males. Each patient underwent an ECG on admission and discharge as well as a laboratory assessment. A comparison between patients with COVID-19 and healthy controls showed significantly higher HR (p < 0.0001) and lower PR values (p = 0.02) in the first group. No arrhythmias or other electrocardiographic abnormalities were detected during hospitalization. The median levels of troponin, NT-proBNP, ferritin, and D-dimer were significantly higher in children aged <2 years, but they fell within the normal range for their age. Our results indicate that a detectable cardiac involvement is very rare in children hospitalized for COVID-19 and not suffering from Multisystem Inflammatory Syndrome in Children (MIS-C) and suggest that routine electrocardiographic assessment is not mandatory in these patients in the absence of cardiac symptoms/signs.