Spectrum of cardiac rhythm abnormalities and heart rate variability during the convalescent stage of dengue virus infection: a Holter study

Abstract

Background: Various minor cardiac rhythm abnormalities have been reported in patients with dengue virus infection. Previous studies have used only random electrocardiograms (ECG) to assess the incidence of cardiac arrhythmias, and the time when the ECGs were undertaken was not systematically defined.

Objectives: To evaluate cardiac arrhythmias and heart rate variability in children with dengue virus infection during the convalescent stage using Holter monitoring.

Methods: Overnight 18–24-hour Holter monitoring was performed in 35 children [mean (SD) age 11·7 (2·3) y] at least 24 hours after defervescence (on the last day of admission). In 17 patients, time- and frequency-domain short-term (5 minutes) heart rate variability (HRV) during the convalescent stage was also compared with the value obtained during the follow-up visit (at least 14 days after defervescence).

Results: During the convalescent stage, cardiac rhythm abnormalities were found in ten patients (29%), including sinus pause (1), first-degree (2) and Mobitz type I second-degree AV block (Wenckebach) (3) and atrial (4) and ventricular ectopic beats (5). There was no relationship between the clinical severity of dengue virus infection (DF, DHF without shock and DSS) and the incidence of cardiac arrhythmia. There was no significant difference in the averaged RR interval, the time-domain HRV (SDNN, RMSSD, pNN 50) or frequency-domain HRV (LF, HF, LF/HF ratio) between the convalescent stage and at follow-up.

Conclusion: Various benign bradyarrhythmias and ectopic beats are detected in patients with dengue virus infection during the convalescent stage.

Keywords:

• Arrhythmia
• children
• dengue
• dengue haemorrhagic fever
• heart rate variability

The study was supported by The Rachadapisek Grant, Faculty of Medicine, Chulalongkorn University.