Electrocardiographic changes in acute Kawasaki disease in the era of immunoglobulin therapy

Abstract Background Kawasaki disease (KD), an acute, febrile, self-limiting, multisystem vasculitis of unknown etiology, often involves the cardiac complications of coronary artery aneurysm development, myocarditis, pericarditis, and valvulitis. However, there is insufficient, epidemiological data on electrocardiographic (ECG) changes in acute KD in the IVIG era, and little is known about the association between ECG changes and the prognosis. Objective The present study aimed to determine the type of ECG changes found in acute KD and to clarify the course of these changes as well as their relationship to disease severity. Methods The present, retrospective, observational study analyzed 201 patients aged < 15 years with Kawasaki disease who received IVIG from April 2021 to March 2023. Results In the 156 eligible patients analyzed (male: 62.8%; median age on admission: 24 months), the most common abnormalities were T wave changes (n=141; 90.4%) on any lead followed by T wave inversions (n=63;40.4%), tachycardia (n=36; 23.1%), and a prolonged PR interval (n=23; 14.7%). PR prolongation, abnormal Q wave, QTc prolongation, and ST changes were less common in the present cohort, and arrhythmia occurred less frequently than in previous studies. No significant association was found between T wave inversion and disease severity. Conclusion T wave changes occurred frequently in the acute phase ECG in KD but were not associated with clinical features, such as unresponsiveness to IVIG therapy or coronary artery abnormalities.