Ventricular repolarization disturbances after high dose intravenous methylprednisolone therapy in children

Background: Reports have documented various cardiovascular disorders and arrhythmias occurring during corticosteroid pulse therapy. This study aimed to assess the impact of high-dose intravenous methylprednisolone on indices of ventricular repolarization in children at Benha University Hospitals. Methods: This observational study included 50 children (30 males, 20 females; mean age 7.1 ± 4.5 years) who received pulse steroid therapy. Each underwent full clinical evaluation, laboratory investigations, and ECG monitoring 4 hours before and 12 hours after methylprednisolone infusion. Results: The most common indications for therapy were nephrotic syndrome (16%), ADEM (10%), GBS (8%), and autoimmune hemolytic anemia (8%). ECG parameters including heart rate (HR), corrected QT interval (cQT), Tpeak-Tend interval (Tp-e), and Tp-e/QTc ratio significantly increased post-therapy, while PR interval significantly decreased (p < 0.05). No significant changes were noted in QRS or JTc. Adverse effects were reported in 46% of patients: fatigue & weakness (18%), headache (22%), irritability (6%), blurred vision (4%), sleep disturbance (10%), GIT irritation (14%), hotness (6%), and palpitation (10%). All patients survived, with 86% responding to steroid therapy alone, while 14% required IVIG. The average hospital stay was 14.2 ± 3.9 days. Conclusion: High-dose intravenous methylprednisolone significantly alters ventricular repolarization markers, indicating a potential risk of arrhythmia in pediatric patients. ECG monitoring is essential during therapy. Identifying at-risk patients early and ensuring careful follow-up can minimize adverse cardiac events.