In 115 children with fulminant myocarditis, all had ECG abnormalities; after treatment, ST-segment depression recovered 100%, T-wave changes 69.7%, with overall favorable prognosis.
What are the electrocardiogram characteristics and long-term recovery outcomes in children with fulminant myocarditis?
Children with fulminant myocarditis universally present with diverse ECG abnormalities, but the majority achieve complete or partial ECG normalization over long-term follow-up, with the exception of right bundle branch block.
Abstract Background Fulminant myocarditis (FM) represents the most severe and distinctive form of myocarditis, often accompanied by a wide range of electrocardiographic (ECG) abnormalities. However, there is currently a lack of systematic characterization of ECG changes in children with FM, highlighting the need for a comprehensive analysis to better understand these patterns and their clinical implications. Methods This study enrolled children diagnosed with FM who were admitted to the Department of Pediatric Cardiology and the Department of Pediatric Intensive Care Medicine at our Hospital between January 2002 and June 2024. The research focused on summarizing the characteristics of ECG changes observed during hospitalization. Follow-up data were collected through outpatient visits, phone calls, WeChat, letters, and other methods to obtain post-discharge ECGs, which were then analyzed to evaluate ECG outcomes. Results Our findings revealed that all children with FM exhibited ECG abnormalities during their illness. Among the survivors, 37 children achieved complete normalization of their ECGs before discharge. Waveform abnormalities were observed in 98 children (85.2%), while arrhythmias occurred in 107 children (93%). The most common waveform abnormality was T-wave changes, with an incidence rate of 62.8%. The most frequent arrhythmia was sinus tachycardia (42.6%), followed by third-degree atrioventricular block (33.9%) and ventricular tachycardia (29.6%). Following comprehensive treatment, all ECG abnormalities resolved effectively. Among survivors, the recovery rate for ST-segment depression reached 100%, while the recovery rates for ST-segment elevation, T-wave changes, and right bundle branch block were lower, at 69%, 69.7%, and 48.8%, respectively. During a median follow-up period of 40 months (71 children), 28 children maintained normal ECGs, 21 achieved complete normalization, 12 showed partial recovery, 8 exhibited no improvement, and 2 developed new ECG changes. The recovery rates for waveform abnormalities during follow-up exceeded 75%, whereas the recovery rates for complete and incomplete right bundle branch block were relatively low, at 28.6% and 36.3%, respectively. Conclusion Children with FM may present with diverse ECG changes, but the overall prognosis is favorable. Early and continuous ECG monitoring is crucial for FM patients to dynamically observe changes and implement timely interventions. This approach can significantly improve outcomes and guide appropriate treatment strategies.
Han et al. (2025) studied this question. In 115 children with fulminant myocarditis, all had ECG abnormalities; after treatment, ST-segment depression recovered 100%, T-wave changes 69.7%, with overall favorable prognosis.