Morr, Igor

Background: The mosquito-borne Chikungunya virus infection is one of the most important emerging virus diseases globally. Local transmission has been found in the United States. There are very few published reports concerning the cardiac complications in general and less of arrhythmias in particular. Chikungunya can be fatal: there have been sudden deaths reports . Objective: To investigate arrhythmic complications of Chikungunya myocarditis. Methods: Prospective multicenter observational study of 280 patients with a Chikunguya infection from a Venezuelan Outbreak. Clinical evaluation, ECG, laboratory including virological evaluation and cardiac biomarkers, Echocardiogram, Holter and cardiac MRI procedures were carried out. Results: Of the 280 patients examined, 113 patients were male, with a mean age of 59 ± 9; 270 patients presented with fever and polyarthralgia and 85 developed palpitations. Arrhythmias occured in 45% of cases; they included bradyarrhythmias (33%), atrial and ventricular ectopic beats and tachyarrhythmias in which atrial fibrillation was observed in 19 cases. There were also ectopic atrial tachycardia and non sustained ventricular tachycardia, conduction disturbances and 3 cases of sudden death. Conclusion: Physicians should know that almost half of the Chikungunya patients will develop arrhythmias and manifest or silent myocarditis. In the proper epidemiological context, the triad of fever, polyarthralgia and new arrhythmia including bradiarrhythmias suggest Chikungunya Myocarditis.

Abstract Background While cardiovascular complications, including arrhythmias are now a recognized manifestation of Multisystem inflammatory syndrome in children (MIS-C), there are no reports of primary bradycardia preceding the clinical presentation. We sought to describe a case series of sinus bradycardia as an initial manifestation of MIS-C. Methods We included a series of 10 consecutive patients with confirmed COVID-19 who met WHO and CDC criteria for MIS-C, who developed sinus bradycardia with a heart rate measured in the awake state that was below the normal range for age for children, as an initial manifestation of the disease, in a prospective observational multicenter study. Patients underwent clinical, laboratory evaluation, ECG, Holter, telemetry, echocardiogram, chest X Ray, and a chest CT scan. Results Of the 10 patients included, 6 were male, with a mean age of 6.52±5.35 years, range 4 months to 14 years. All cases were Hispanic. Bradycardia was transient and did not merit treatment. Coronary abnormalities were noted in 6 cases; 4 patients had mild coronary ectasia; 9 patients had pericardial effusion with no evidence of tamponade. All patients had a mild clinical course; none had shock, heart failure, the need for mechanical ventilation, or died. All blood markers (Troponin, BNP, Platelet count, C-reactive protein, D-dimer, Ferritin) returned to normal levels by discharge/follow-up with a favorable outcome including resolution of coronary dilatation in all but 2 in which aneurysm persisted. Treatment All patients received steroids and low-weight-molecular heparin 10 patients, 8 aspirin and 8 intravenous immunoglobulins. Conclusion Sinus bradycardia may be the initial manifestation of MIS-C, usually transient and mild. Physicians should be aware of this presentation. Funding Acknowledgement Type of funding sources: None. Kid, MIS-C. Bradycardia/Atrial Rhythm

Introduction: It has been estimated that up to a billion people worldwide could be exposed to Zika re-emergence including North America. Zika was considered the worst outbreak of the century before COVID-19. There are only few reports of cardiac complications and the long-term risk of heart failure (HF) is unknown. This is the objective of this study. Methods: We included 19 patients who developed acute myocarditis within one week of symptomatic Zika, in a prospective observational multi-center study. Patients underwent clinical, laboratory evaluation including Zika confirmation, ECG, echocardiogram, Holter, cardiac MRI, coronary arteriography (2). Patient follow-up examinations were performed at 2, 6,12, 24, 36 and 48 months. Results: Of the 19 patients, 12 (63%) were female with a mean age of 49 ± 17 years with a median follow-up of 3 years. Nine patients (47%) developed acute HF; 8 (42%) with reduced ejection fraction (HFrEF) and one with preserved EF (HFrEF) and moderate to severe pericardial effusion. Two cases died suddenly in the first week of Zika onset, both with HFrEF. Treatment included sacubitril /valsartan, or ace-inhibitors, SGLT2 inhibitors, beta-blockers, aldosterone-blockers, cardiovascular rehabilitation, and in one case cardiac resynchronization therapy plus implanted defibrillator. There was no new HF onset after the acute phase of the disease. Myocarditis resolved in 10 (56%) patients. Persistent atrial and ventricular arrhythmia with normal EF observed in 5 (26%) of cases. Altogether, characteristic features of dilated cardiomyopathy that developed in 7 patients (36, 8%); 2 (11%) of them died. Conclusion: Almost half of the patients with Zika myocarditis developed acute HF during the first week of disease onset, none of the patients developed HF after the acute phase. A 3-year mortality rate of 10,5 % was observed.