Impact of Extracorporeal Membrane Oxygenation on Acute Fulminant Myocarditis-related Hemodynamic Compromise Arrhythmia in Children

• Published in: Pediatrics and neonatology 2016-12, Vol.57 (6), p.480-487
• Main Authors: Lin, Kuan-Miao, Li, Ming-Hsiu, Hsieh, Kai-Sheng, Kuo, Hsuan-Chang, Cheng, Ming-Chou, Sheu, Jiunn-Jye, Lin, Ying-Jui
• Format: Article
• Language: English
• Subjects: atrioventricular block; cardiogenic shock; extracorporeal membrane oxygenation; fulminant myocarditis; Internal Medicine; Pediatrics; ventricular tachycardia
• ISSN: 1875-9572
• DOI: 10.1016/j.pedneo.2016.02.002

Background Acute fulminant myocarditis (AFM) commonly presents as abrupt cardiogenic shock with or without dysrhythmia. This study evaluated the impact of extracorporeal membrane oxygenation (ECMO) on AFM-related hemodynamic compromise dysrhythmias. We also reported the clinical experience of AFM at our hospital. Methods Eighteen children diagnosed with AFM were enrolled. Demographic variables, laboratory data, and clinical courses were reviewed. Thirteen surviving patients with hemodynamic compromise arrhythmia [complete atrioventricular block (CAVB) or ventricular tachycardia (VT)] during hospitalization were divided into Group A (ECMO group; n  = 7) and Group B (non-ECMO group; n  = 6). Results The overall survival rate was 78% (14/18). There were no cases of mortality after ECMO was introduced at our hospital. Common symptoms at diagnosis included general malaise (94%), gastrointestinal symptoms (89%), chest pain (56%), shortness of breath (56%), and seizure/syncope (56%). In addition to abnormal cardiac enzyme levels, all patients displayed elevated alanine aminotransferase levels during early disease stages. Electrocardiography at diagnosis revealed dysrhythmia in 15 patients, namely, CAVB in 11 patients (61%) and VT in four patients (22%). During hospitalization, the dysrhythmia shifted from CAVB to VT in 10 patients and from sinus tachycardia to VT in one patient. New episodes of VT were common (overall occurrence rate, 83%). Although myocardial damage and dysfunction were more severe in Group A, the time to rhythm recovery in this group was shorter than that in Group B (median time, 1.7 days vs. 7.35 days, p  = 0.045). All surviving patients had normal ventricular function at 6-month follow-up. Conclusion Hemodynamic compromise arrhythmia is common in AFM patients and may cause rapid deterioration. Simply correcting sinus rhythm is not always sufficient because of myocardium instability. Timely use of ECMO can improve the survival rate and shorten the time to recapture sinus rhythm in AFM patients with CAVB or VT.