The incidence of arrhythmias during exercise stress tests among children with Kawasaki disease: A single-center case series

Varun Aggarwal, Kristen Sexson-Tejtal, Wilson Lam, Santiago O. Valdes, Caridad M. de la Uz, Jeffrey J. Kim, Christina Y. Miyake

Research output: Contribution to journalArticle

Abstract

Objective: Based on 2017 guidelines, participation in competitive sports with prior history of Kawasaki Disease (KD) requires those with coronary artery aneurysms (CAA) z score ≥ 5 to undergo evaluation for evidence of inducible ischemia or arrhythmias. The use of exercise stress testing (EST) to evaluate arrhythmias among KD patients has never been reported. This retrospective single-center case series study sought to describe the presence of inducible arrhythmias during EST in KD patients with or without CAA. Methods: Single-center retrospective review of medical records of patients diagnosed with KD between 1989-2015 at Texas Children’s Hospital, Houston, Texas who underwent EST were included. Results: Among 1007 patients diagnosed with KD, 95 (9%) underwent 165 ESTs at a median time of 9.6 years (IQR 5.8-11.3 years) from diagnosis. Of these 95 patients, 37 had normal coronaries, 21 dilated (z score 2 to <2.5), 10 small (5 >z ≥2.5), 12 medium (10>z ≥ 5 absolute dimension <8 mm), 10 large (z ≥10 or absolute dimension ≥8 mm), 5 severe (myocardial infarct or bypass graft). Supraventricular tachycardia was not seen. Ventricular arrhythmias during EST were uncommon and seen only among patients with CAA z ≥5. Ventricular tachycardia occurred in a single patient with a large CAA, known VT and ICD. High-grade ventricular ectopy was seen in one patient who had severe CAA and underwent bypass grafting. Conclusions: Arrhythmias on EST were noted only among patients with CAA z ≥5. The current guidelines are a reasonable approach to increasing healthy activity among KD patients. Clarification regarding which inducible arrhythmias meet criteria for activity restriction may be helpful to guide sport participation.

Original languageEnglish (US)
Pages (from-to)1032-1036
Number of pages5
JournalCongenital Heart Disease
Volume14
Issue number6
DOIs
StatePublished - Nov 1 2019

Keywords

  • Kawasaki disease
  • aneurysm
  • arrhythmia
  • coronary artery
  • exercise stress test
  • sports participation

PubMed: MeSH publication types

  • Journal Article

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