Skip to main content

Clinical analysis of temporary pacemaker implantation in 6 children with fulminant myocarditis



There is little literature on the use of temporary pacemakers in children with fulminant myocarditis. Therefore, we summarized the use of temporary cardiac pacemakers in children with fulminant myocarditis in our hospital.


The clinical data of children with fulminant myocarditis treated with temporary pacemakers in Wuhan Children’s Hospital from January 2017 to May 2022 were retrospectively analyzed.


A total of 6 children were enrolled in the study, including 4 boys and 2 girls, with a median age of 50 months and a median weight of 15 kg. The average time from admission to pacemaker placement was 2.75 ± 0.4 h. The electrocardiogram showed that all 6 children had third-degree atrioventricular block (III°AVB). The initial pacing voltage, the sensory sensitivity of the ventricle and the pacing frequency were set to 5–10 mV, 5 V and 100–120 bpm respectively. The sinus rhythm was recovered in 5 patients within 61 h (17–134) h, and the median time of using temporary pacemaker was 132 h (63–445) h. One of the children had persistent III°AVB after the temporary pacemaker. With parental consent, the child was fitted with a permanent pacemaker on the 12th day of his illness.


When fulminant myocarditis leads to severe bradycardia or atrioventricular block in children, temporary pacemakers have the characteristics of high safety to improve the heart function.

Peer Review reports

Fulminant myocarditis, a fatal inflammatory disease of the cardiac muscle, often results in decreased cardiac systolic function or conduction disturbances. When fulminant myocarditis affects the function of cardiac autorhythmic cell or conduction system, severe bradycardia or atrioventricular block may occur. At this point, a temporary pacemaker needs to be installed which is a kind of non-permanent electronic device and has been used more and more in children with acute and critical cardiovascular diseases [1]. There are few studies on temporary pacemakers in children with fulminant myocarditis. Therefore, we retrospectively analyzed the clinical data of children with fulminant myocarditis treated with temporary pacemaker in Wuhan Children’s Hospital from January 2017 to May 2022, and summarized the experience of the application of temporary pacemaker in fulminant myocarditis.


This study retrospectively analyzed children diagnosed with fulminant myocarditis and treated with temporary pacemakers at Wuhan Children’s Hospital from January 2017 to May 2022. Demographic and baseline characteristics (age, sex, weight), clinical characteristics, laboratory tests (creatine kinase myocardial band, hypersensitive cardiac troponin T, N-terminal pro-B type natriuretic peptide), and echocardiography were obtained from the electronic medical record system. Temporary pacemaker data included time of pacemaker implantation after admission, pacing parameters, working hours, and clinical outcomes after implantation.

Statistical analysis

The SPSS 22.0 software was used for data processing, in which the count data was represented by case number and percentage. The continuous variable of non-normal distribution was denoted by the median (interquartile range) and the continuous variable of the normal distribution was denoted by the mean ± standard deviation.


A total of 6 children were included in this study, including 4 boys and 2 girls, whose age distribution was between 4 and 91 months, with a median age of 50 months, and weight distribution between 10 and 21 kg, with a median weight of 15 kg.

All 6 children received methylprednisolone and immunoglobulin to modulate immunotherapy and actively performed an electrocardiogram after admission. All were diagnosed with III°AVB, and two children had concurrent ventricular tachycardia. The clinical symptoms of the 6 children were weakness in 5 cases, vomiting in 4 cases, and syncope and convulsions in one case each. Heart rate at admission ranged from 0 to 79 beats/minute, with a mean heart rate of 55 beats/minute. There were 3 cases of cardiogenic shock and 3 cases of Adams-Stokes syndrome. Echocardiography was performed on admission in all 6 children. The mean left ventricular ejection fraction (LVEF) was 53.0 ± 6.7% and the mean shortening fraction (LVFS) was 28.8 ± 8.1%. The range of CK-MB values at admission was 50 to 1636 U/L, with a median of 78 U/L. The values of hs-cTnT ranged from 0.031 to 6.62 ng/ml, with a median of 2.77 ng/ml. NT-proBNP levels ranged from 2745 to 9000 pg/ml, with a median of 9000 pg/ml. The average time from admission to temporary pacemaker placement was 2.7 ± 0.4 h. All pacemaker modes were set to VVI mode. The initial stimulation voltage, sensory sensitivity, and stimulation frequency were set at 5–10 mV, 5 V, and 100–120 beats per minute, respectively. After temporary pacemaker placement, sinus rhythm was gradually restored within 61 h (17–134) hours in 5 patients, and the median time of temporary pacemaker use was 132 h (63–445) hours. A permanent pacemaker was installed in one patient whose electrocardiogram remained III°AVB on the 12th day of illness (Table 1).

Table 1 Clinical data and of 6 children with fulminant myocarditis


Fulminant myocarditis is an acute inflammatory disease of cardiac myocytes that can lead to left ventricular dysfunction, cardiogenic shock, and refractory life-threatening arrhythmias [2,3,4]. Aggressive treatment of hemodynamic failure and severe arrhythmias in fulminant myocarditis is critical [5, 6]. Among other things, temporary pacemakers would play a crucial role in improving some bradyarrhythmia diseases.

Temporary pacemakers provide an effective cardiac pacing rate to stabilize the heartbeat, thereby increasing cardiac output, hemodynamics, and end-organ perfusion [2]. In this study, III°AVB was present in all six children with fulminant myocarditis who underwent temporary pacemaker insertion with parental consent. In five of the six reported cases, sinus rhythm returned to normal after effective treatment with the temporary pacemaker, which was subsequently successfully removed. Only the last child suffered from III°AVB after 115 h of treatment with a temporary pacemaker and his mental health was still poor, the child was finally implanted with a permanent pacemaker.

When fulminant myocarditis severely affects cardiac muscle cells, autorhythmic cells and conduction system, combination treatment can improve the cure rate of the disease. A life support-based comprehensive treatment regimen (LSBCTR) proposed by DW Wang includes mechanical life support, intravenous infusion of glucocorticoids and immunoglobulin, and neuraminidase inhibitors (e.g., oseltamivir), which significantly improves the cure rate of fulminant myocarditis [7,8,9]. ECMO can effectively support circulatory and respiratory functions until patients have sufficiently recovered. Therefore, ECMO is currently a popular choice for mechanical circulation-assisted treatment of fulminant myocarditis in children. Due to its convenience and effectiveness, ECMO is widely used in the treatment of fulminant myocarditis in children [10, 11]. The last child we report was hospitalized in the intensive care unit for two days because of vomiting, fever, and weakness and was diagnosed with III°AVB and ventricular tachycardia. Methylprednisolone and immunoglobulin were used concomitantly, and the child had a temporary cardiac pacemaker inserted within 3 h of admission. However, after medical therapy and electrical defibrillation, ventricular tachycardia still existed and the child’s hemodynamics were unstable. Therefore, the child underwent ECMO within 24 h of admission. After 12 h of combined treatment with ECMO and the temporary pacemaker, sinus rhythm was achieved and blood pressure remained stable. Finally, the ECMO was successfully removed after 163 h of supportive circulation.

Arrhythmic events such as atrioventricular block that occur in fulminant myocarditis are transient events that occur after cardiomyocytes become swollen or damaged. After active and effective treatment, the function of some damaged cardiomyocytes gradually recovered, the subsequent sinus rhythm persisted, and the atrioventricular block disappeared. Therefore, we have summarized the time to return to sinus rhythm and the total time to insertion of the temporary pacemaker in the table. On this basis, we can roughly understand the recovery time of damaged cardiomyocytes in children with fulminant myocarditis and serve as a reference for assessing the total time required for the use of temporary pacemakers.

The onset of fulminant myocarditis is rapid and severe. Therefore, early detection and active treatment are the key to improving the cure rate. Temporary pacemakers have important clinical value for patients with hemodynamic instability due to bradyarrhythmia. When temporary pacemakers are still unable to correct hemodynamic stability, combined ECMO therapy can effectively improve outcomes, thereby improving children’s prognosis.

Data availability

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.



III° atrioventricular block


creatine kinase myocardial band


hypersensitive cardiac troponin T

NT-pro BNP:

N-terminal pro-B type natriuretic peptide


  1. Li TT, Cheng J. Clinical analysis of temporary pacemaker implantation in 13 children. Translational Pediatr. 2022;11:174–82.

    Article  CAS  Google Scholar 

  2. Ye S, Zhu L, Ning B, Zhang C. Combined application of extracorporeal membrane oxygenation and an artificial pacemaker in fulminant myocarditis in a child. Turk Pediatri Ars. 2017;52:101–4.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kodama M, Oda H, Okabe M, Aizawa Y, Izumi T. Early and long-term mortality of the clinical subtypes of Myocarditis. Jpn Circ J. 2001;11:961–4.

    Article  Google Scholar 

  4. Tsutomu Sj, Hiroyuki M, Kei H, Toshio N, Eiichi Y, Hirotaka Ohki, et al. Comparison of the clinical presentation, treatment, and outcome of fulminant and acute myocarditis in children. Circ J. 2012;5:1222–8.

    Google Scholar 

  5. Heinsar S, Raman S, Suen JY, Cho HJ, Fraser JF. The use of extracorporeal membrane oxygenation in children with Acute Fulminant myocarditis. Clin Exp Pediatr. 2021;5:188–95.

    Article  Google Scholar 

  6. Sharma AN, Stultz JR, Bellamkonda N, Amsterdam EA. Fulminant myocarditis: Epidemiology, Pathogenesis, diagnosis, and management. Am J Cardiol. 2019;12:1954–60.

    Article  Google Scholar 

  7. Wang DW, Li S, Jiang JG, Yan JT, Zhao CX, Wang Y, et al. Chinese society of cardiology expert consensus statement on the diagnosis and treatment of adult fulminant myocarditis. Sci China Life Sci. 2019;2:187–202.

    Article  Google Scholar 

  8. Hang W, Chen C, Seubert JM, Wang DW. Fulminant myocarditis: a comprehensive review from etiology to treatments and outcomes. Signal Transduct Target Ther. 2020;5:287.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Li S, Xu S, Li C, Ran X, Cui G, He M, et al. A life support-based comprehensive treatment regimen dramatically lowers the in-hospital mortality of patients with fulminant myocarditis: a multiple center study. Sci China Life Sci. 2019;3:369–80.

    Article  Google Scholar 

  10. Yamamoto LG, Young LL. Acute-onset dysrhythmia heralding fulminant myocarditis and refractory cardiac arrest treated with ED cardiopulmonary bypass and extracorporeal membrane oxygenation. Am J Emerg Med. 2007;3:348–52.

    Article  Google Scholar 

  11. Makoto T, Motomi S, Mitsumasa H, Akira S, Misuru L, Isamu Y, et al. Child with fulminant myocarditis survived by ECMO support–report of a child case. Ann Thorac Cardiovasc Surg. 2007;1:60–4.

    Google Scholar 

Download references


The authors are deeply grateful to all who participated in this study.


This work was no funding support.

Author information

Authors and Affiliations



Study conception and design: M. Z.; data collection: M. Z., X.F.C.; analysis and interpretation of results: X.F.C. and Y.Z.; draft manuscript preparation: M.Z. and Y.Z., All authors reviewed the results and approved the final version of the manuscript.

Corresponding author

Correspondence to Yong Zhang.

Ethics declarations

Ethics approval and consent to participate

Ethical approval was obtained by the ethical committee of Wuhan Children’s Hospital. Parents of the infant provide written informed consent for the publication of the personal data and accompanying images presented in this manuscript.

Consent for publication

Written informed consent was obtained from the patient’s legal guardians for publication of this case report and any accompanying images.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, M., Cai, X. & Zhang, Y. Clinical analysis of temporary pacemaker implantation in 6 children with fulminant myocarditis. J Cardiothorac Surg 19, 296 (2024).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: