Differential diagnosis of cardiac arrhythmias in infants with whooping cough

Introduction. Cardiac arrhythmias have not been considered as complications of whooping cough so far. The relevance of the study is conditioned by the need to improve the tactics of management of infants with whooping cough, having the most severe course of the disease, taking into account the identified arrhythmias, as well as the lack of study of this problem.

Aim. To develop an algorithm for the differential diagnosis of cardiac arrhythmias in infants with whooping cough to determine the tactics of their treatment and follow-up, taking into account the presumed pathogenesis of arrhythmias.

Materials and methods. The study included infants (n = 56; 55.4% – male) infants with whooping cough hospitalized in the intensive care unit of Federal Research and Clinical Center for Infectious Diseases. Using functional methods of diagnostics in cardiology and results of 24-hour recording from the intensive care unit monitors we have for the first time compared the heart rhythm with episodes of respiratory rhythm disturbance affected by this disease.

Results. In 83.9% of patients with whooping cough, the ECG parameters were normal. Apnea due to spasmodic coughing was observed in 23 children (41.1%) and was accompanied by desaturation and bradycardia. According to Holter ECG monitoring, all children had sinus bradycardia, atrial rhythm episodes, and extrasystoles. Five patients (8.93%) had sinus arrest with a maximum rhythm pause of 3020 milliseconds. No pathological arrhythmias were detected in the absence of respiratory rhythm disturbance. We suggested a connection between asystole and apnea with parasympathetic hyperactivity, increased sensitivity of the heart to vagal influences, and identified two main groups of patients with whooping cough based on the possible pathogenesis of cardiac arrhythmias.

Conclusions. The identification and differential diagnosis of cardiac arrhythmias in infants with whooping cough is important in determining their treatment and follow-up. Further research is needed to study this issue.

1. Li Z, Qin L, Xu X, Chen R, Zhang G, Wang B et al. Immune modulation: the key to combat SARS-CoV-2 induced myocardial injury. Front Immunol. 2025;16:1561946. https://doi.org/10.3389/fimmu.2025.1561946.

2. Kounis NG, Gogos C, de Gregorio C, Hung MY, Kounis SN, Tsounis EP et al. “When,” “Where,” and “How” of SARS-CoV-2 Infection Affects the Human Cardiovascular System: A Narrative Review. Balkan Med J. 2024;41(1):7–22. https://doi.org/10.4274/balkanmedj.galenos.2023.2023-10-25.

3. Ståhlberg M, Fischer K, Tahhan M, Zhao A, Fedorowski A, Runold M et al. Post-Acute COVID-19 Syndrome: Prevalence of Peripheral Microvascular Endothelial Dysfunction and Associations With NT-ProBNP Dynamics. Am J Med. 2025;138(6):1019–1028. https://doi.org/10.1016/j.amjmed.2024.10.012.

4. Long B, Brady WJ, Bridwell RE, Ramzy M, Montrief T, Singh M, Gottlieb M. Electrocardiographic manifestations of COVID-19. Am J Emerg Med. 2021;41:96–103. https://doi.org/10.1016/j.ajem.2020.12.060.

5. Ahmadi A, Sabri MR, Ghaderian M, Dehghan B, Mahdavi C, Mohkamkar N. Cardiovascular Complications in Children Post COVID-19: A Systematic Review. Adv Biomed Res. 2024;13:94. https://doi.org/10.4103/abr.abr_319_23.

6. Navolokina A, Smereka J, Böttiger BW, Pruc M, Juárez-Vela R, Rahnama-Hezavah M et al. The Impact of COVID-19 on Pediatric Cardiac Arrest Outcomes: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2023;20(2):1104. https://doi.org/10.3390/ijerph20021104.

7. Samuel S, Friedman RA, Sharma C, Ganigara M, Mitchell E, Schleien C, Blaufox AD. Incidence of arrhythmias and electrocardiographic abnormalities in symptomatic pediatric patients with PCR-positive SARS-CoV-2 infection, including drug-induced changes in the corrected QT interval. Heart Rhythm. 2020;17(11):1960–1966. https://doi.org/10.1016/j.hrthm.2020.06.033.

8. Lee PY, Garan H, Wan EY, Scully BE, Biviano A, Yarmohammadi H. Cardiac arrhythmias in viral infections. J Interv Card Electrophysiol. 2023;66(8):1939–1953. https://doi.org/10.1007/s10840-023-01525-9.

9. Manchandani U, Anwar S, Acharya S, Thapa S, Elsayegh D, Anwar M. Asystole in COVID-19 Infection: A Case Report. Cureus. 2021;13(7):e16346. https://doi.org/10.7759/cureus.16346.

10. Avanesyan GA, Filatov AG. Cardiac arrhythmias after COVID-19. Epidemiology, etiology and pathophysiology. Annaly Aritmologii. 2023;20(1):52–58. (In Russ.) https://doi.org/10.15275/annaritmol.2023.1.6.

11. Buttà C, Zappia L, Laterra G, Roberto M. Diagnostic and prognostic role of electrocardiogram in acute myocarditis: A comprehensive review. Ann Noninvasive Electrocardiol. 2020;25(3):e12726. https://doi.org/10.1111/anec.12726.

12. Rybalko NA, Korableva NN, Kotlukova NP, Makarov LM. Cardiorespiratory monitoring of healthy children in the first year of life. Pediatriya – Zhurnal im G.N. Speranskogo. 2018;97(3):8–15. (In Russ.) Available at: https://pediatriajournal.ru/archive?show=364&section=5227

13. Kawashima H, Inagaki N, Nakayama T, Morichi S, Nishimata S, Yamanaka G, Kashiwagi Y. Cardiac Complications Caused by Respiratory Syncytial Virus Infection: Questionnaire Survey and a Literature Review. Glob Pediatr Health. 2021;8:2333794X211044114. https://doi.org/10.1177/2333794X211044114.

14. Oulego-Erroz I, de Castro-Vecino P, Ocaña-Alcober C, Gutiérrez-Marqués S, Martínez-Badás JP, Centeno-Jiménez M. Complete atrioventricular block associated with respiratory syncytial virus: Presentation of a case and a literature review. An Pediatr. 2021;94(6):417–419. https://doi.org/10.1016/j.anpede.2020.06.013.

15. Raphael A, Schlesinger Y, Nir A. Sinus arrest during respiratory syncytial virus bronchiolitis: A report of two cases and literature review. Pediatr Pulmonol. 2023;58(11):3330–3332. https://doi.org/10.1002/ppul.26589.

16. Gavotto A, Ousselin A, Pidoux O, Cathala P, Costes-Martineau V, Rivière B et al. Respiratory syncytial virus-associated mortality in a healthy 3-year-old child: a case report. BMC Pediatr. 2019;19(1):462. https://doi.org/10.1186/s12887-019-1847-2.

17. Wu Y, Gan C. Clinical characteristics and impact of exchange transfusion in infant pertussis with extreme leukocytosis. Ital J Pediatr. 2025;51(1):82. https://doi.org/10.1186/s13052-025-01933-9.

18. Huo J, Chen S, Qin Y, Xu F, Liu C. Risk factors and mortality in children with severe pertussis: the role of exchange transfusion in a PICU. Ital J Pediatr. 2025;51(1):108. https://doi.org/10.1186/s13052-025-01951-7.

19. Cousin VL, Caula C, Vignot J, Joye R, Blanc M, Marais C, Tissières P. Pertussis infection in critically ill infants: meta-analysis and validation of a mortality score. Crit Care. 2025;29(1):71. https://doi.org/10.1186/s13054-025-05300-2.

20. Hanna S, Samies N. Clinical progress note: Pertussis. J Hosp Med. 2025. https://doi.org/10.1002/jhm.70080.

21. Winter K, Zipprich J, Harriman K, Murray EL, Gornbein J, Hammer SJ et al. Risk Factors Associated With Infant Deaths From Pertussis: A Case-Control Study. Clin Infect Dis. 2015;61(7):1099–1106. https://doi.org/10.1093/cid/civ472.

22. Berger JT, Carcillo JA, Shanley TP, Wessel DL, Clark A, Holubkov R et al. National Institute of Child Health and Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN). Critical pertussis illness in children: a multicenter prospective cohort study. Pediatr Crit Care Med. 2013;14(4):356–365. https://doi.org/10.1097/PCC.0b013e31828a70fe.

23. Caballero Mora FJ, Sanz Santiago V, Tamariz-Martel Moreno A, Serrano González A, Baño Rodrigo A. Atrial and ventricular arrhythmias in a child with whooping cough. An Pediatr. 2012;77(6):420–422. https://doi.org/10.1016/j.anpedi.2012.05.003.

24. Carvalho VEL, Couto TB, Moura BMH, Schvartsman C, Reis AG. Atropine does not prevent hypoxemia and bradycardia in tracheal intubation in the pediatric emergency department: observational study. Rev Paul Pediatr. 2023;42:e2022220. https://doi.org/10.1590/1984-0462/2024/42/2022220.

25. Sweet DG, Carnielli VP, Greisen G, Hallman M, Klebermass-Schrehof K, Ozek E et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update. Neonatology. 2023;120(1):3–23. https://doi.org/10.1159/000528914.

26. Akhapkina ES, Balashova EN, Burov AA, Degtyarev DN, Zubkov VV, Zuykov OA et al. Apnea of prematurity (draft of clinical guidelines). Neonatology: News, Opinions, Training. 2023;11(4):53–67. (In Russ.) https://doi.org/10.33029/ 2308-2402-2023-11-4-53-67.

27. Kabbani MS, Al Taweel H, Kabbani N, Al Ghamdi S. Critical arrhythmia in postoperative cardiac children: Recognition and management. Avicenna J Med. 2017;7(3):88–95. https://doi.org/10.4103/ajm.AJM_14_17.

28. Leung AKC, Leung AAM, Wong AHC, Hon KL. Breath-Holding Spells in Pediatrics: A Narrative Review of the Current Evidence. Curr Pediatr Rev. 2019;15(1):22–29. https://doi.org/10.2174/1573396314666181113094047.

29. Gonzalez Corcia MC, Bottosso A, Loeckx I, Mascart F, Dembour G, François G. Efficacy of treatment with belladonna in children with severe pallid breath-holding spells. Cardiol Young. 2018;28(7):922–927. https://doi.org/10.1016/j.anpedi.2012.05.003.

30. Швалко АД. Коклюш у детей. Ленинград: Медицина; 1974. 189 с.