key: cord-1016429-7gkqs2xx
authors: Domico, Michele; McCanta, Anthony C.; Hunt, Juliette L.; Ashouri, Negar; Nugent, Diane; Kelly, Robert B.
title: High-Grade Heart Block Requiring Transvenous Pacing Associated with Multisystem Inflammatory Syndrome in Children During the COVID-19 Pandemic
date: 2020-08-25
journal: HeartRhythm Case Rep
DOI: 10.1016/j.hrcr.2020.08.015
sha: af3e2a32e59b13d486800eeda11f13b41a602325
doc_id: 1016429
cord_uid: 7gkqs2xx

nan

Funding: This case report did not receive any specific grant from funding agencies in the public, 42 commercial, or not-for-profit sectors. The differential diagnosis included bacterial and viral pneumonia. Toxic shock syndrome, early mechanism of the variable intraventricular conduction during bradycardia, the resulting cardiac 157 output was insufficient to meet his metabolic demands.

Although the therapeutic strategy was unproven in this clinical scenario, we speculate that the 160 treatment aimed at mitigating a profound inflammatory response, namely the combination of 161 methylprednisolone and IVIG, likely reversed the conduction system insult in our patient. respectively. In addition, on hospital days 3, 5, 6 and 7, the patient's D-Dimer was 8.80, 3.71, 166 3.14 and 2.76 mCg/mL FEU, respectively. The initiation of transvenous pacing along with the combination of aggressive anti-inflammatory therapies appeared to rapidly improve the patient's condition and ultimately reverse the high-178 grade heart block. This case highlights that high-grade conduction system disease, including 179 high-grade heart block, variable atrioventricular block and intraventricular conduction 180 abnormalities, is a potential complication of MIS-C, requiring close observation and the need for 181 advanced invasive cardiac intervention.

Acknowledgements: 184 We would like to thank Anjan S. Batra, MD, FHRS for his assistance with this case. Figure 1 : Electrocardiogram demonstrating second-degree type II heart block. 

Hyperinflammatory shock in children during COVID-19 pandemic

Multisystem inflammatory syndrome 199 in U.S. children and adolescents

Clinical characteristics of 58 children 201 with a pediatric inflammatory multisystem syndrome temporally associated with SARS

Coinfection of SARS-CoV-2 and multiple 204 respiratory pathogens in children

Clinical characteristics of children with coronavirus 208 disease 2019 in Hubei, China

Rates of co-infection between SARS-CoV-210 2 and other respiratory pathogens

Kawasaki disease: multiple giant coronary aneurysms 222 intervention and pacemaker implantation due to complete heart block-a case report

Multisystem Inflammatory Syndrome in Children (MIS-C) has recently been described in pediatric patients associated with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) during the Coronavirus Disease

High-grade heart block is a potential complication of MIS-C, requiring close observation and the need for advanced invasive cardiac intervention, such as transvenous pacing