{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T22:08:42Z","timestamp":1785017322913,"version":"3.55.0"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2021,10,14]],"date-time":"2021-10-14T00:00:00Z","timestamp":1634169600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,12,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Multisystem inflammatory syndrome in children (MIS-C) is a rare life-threatening clinical condition that can develop in patients younger than 21 years of age with a history of infection\/exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The cardiovascular system is a main target of the inflammatory process that frequently causes myocardial dysfunction, myopericarditis, coronary artery dilation, hypotension, and shock. Multisystem inflammatory syndrome in children-associated myocarditis is usually characterized by fever, tachycardia, non-specific electrocardiogram abnormalities, and left ventricular dysfunction, but serious tachyarrhythmias may also occur. We report two cases of patients with MIS-C-associated myocarditis who developed severe bradycardia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>Two female adolescents with recent history of coronavirus disease 2019 (COVID-19) were initially hospitalized for long-lasting high-grade fever and severe gastrointestinal symptoms. Both patients were diagnosed with MIS-C-associated myocarditis for elevation of markers of myocardial injury (mean highly-sensitive cardiac troponin 2663 pg\/mL, mean N-terminal-pro-brain natriuretic peptide 5097 pg\/mL) and left ventricular dysfunction, which was subsequently confirmed by cardiac magnetic resonance. Both patients developed a severe sinus bradycardia (lowest heart rate 36 and 42, respectively), which appeared refractory to the treatment with intravenous Methylprednisolone and Immunoglobulins, despite a clinical and biochemical improvement. The use of Anakinra (a recombinant interleukin-1 receptor antagonist), was associated with a rapid improvement of cardiac rhythm and excellent clinical outcome at 6 months of follow-up.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>In patients with MIS-C-associated myocarditis, a continuous cardiac monitoring is mandatory to promptly identify potential conduction abnormalities. Adolescents may present bradycardia as a rhythm complication. We experienced a rapid recovery after treatment with Anakinra, to be considered as add-on therapy in cases refractory to standard anti-inflammatory treatment.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytab405","type":"journal-article","created":{"date-parts":[[2021,10,18]],"date-time":"2021-10-18T11:51:34Z","timestamp":1634557894000},"source":"Crossref","is-referenced-by-count":13,"title":["Bradycardia associated with Multisystem Inflammatory Syndrome in Children with COVID-19: a case series"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0741-0136","authenticated-orcid":false,"given":"Gian Paolo","family":"Ciccarelli","sequence":"first","affiliation":[{"name":"Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Via S. Pansini, 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8578-729X","authenticated-orcid":false,"given":"Eugenia","family":"Bruzzese","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Via S. Pansini, 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaetano","family":"Asile","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Sciences, Section of Cardiology, University of Naples Federico II, Via S. Pansini, 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5051-8076","authenticated-orcid":false,"given":"Edoardo","family":"Vassallo","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Via S. Pansini, 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6096-7497","authenticated-orcid":false,"given":"Luca","family":"Pierri","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Via S. 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