Bradyarrhythmias in patients with COVID‐19: Marker of poor prognosis?

Abstract

Background: Despite descriptions of various cardiovascular manifestations in patients with coronavirus disease 2019 (COVID-19), there is a paucity of reports of new onset bradyarrhythmias, and the clinical implications of these events are unknown. Methods: Seven patients presented with or developed severe bradyarrhythmias requiring pacing support during the course of their COVID-19 illness over a 6-week period of peak COVID-19 incidence. A retrospective review of their presentations and clinical course was performed. Results: Symptomatic high-degree heart block was present on initial presentation in three of seven patients (43%), and four patients developed sinus arrest or paroxysmal high-degree atrioventricular block. No patients in this series demonstrated left ventricular systolic dysfunction or acute cardiac injury, whereas all patients had elevated inflammatory markers. In some patients, bradyarrhythmias occurred prior to the onset of respiratory symptoms. Death from complications of COVID-19 infection occurred in 57% (4/7) patients during the initial hospitalization and in 71% (5/7) patients within 3 months of presentation. Conclusions: Despite management of bradycardia with temporary (3/7) or permanent leadless pacemakers (4/7), there was a high rate of short-term morbidity and death due to complications of COVID-19. The association between new-onset bradyarrhythmias and poor outcomes may influence management strategies for acutely ill patients with COVID-19.

Severe Sinus Bradycardia: An Unusual Cardiac Manifestation of COVID-19

“…Of course, pulmonary hypertension, severe acute respiratory distress syndrome, and heart failure that strain the right ventricle can each predispose a patient to an increased risk of arrhythmias. 3 , 4 However, our echocardiogram did not reveal a significant dilation in her chamber. Other causes, like myocardial ischemia and electrolyte imbalance, were excluded, given the lack of new regional wall motion abnormality, normal troponin levels, brain natriuretic peptide, and normal electrolytes.…”

“…The potential underlying mechanisms include hypoxia, autonomic dysregulation, myocarditis, exaggerated immune response (eg, cytokine storm), myocardial stretch, myocardial ischemia, electrolyte imbalances, intravascular volume depletion, and drug-induced side effects. 3 Unfortunately, there is a paucity of research on bradyarrhythmias among COVID-19 patients (compared with tachyarrhythmias), 4 and bradyarrhythmia indicates a poor prognosis, even without coexistent acute cardiac injury. 4 …”

“… 3 Unfortunately, there is a paucity of research on bradyarrhythmias among COVID-19 patients (compared with tachyarrhythmias), 4 and bradyarrhythmia indicates a poor prognosis, even without coexistent acute cardiac injury. 4 …”

Multiple Sinus Pauses in a Patient With COVID-19

“…The prognostic impact of sinus pauses in COVID‐19 infection is not well known due to the relative paucity of reported cases. While asymptomatic cases that have been described in the literature till date seem to have recovered from the infection [ 3 - 4 ], most of the reported cases with symptomatic sinus node dysfunction associated with COVID‐19 have had poor prognosis despite permanent pacemaker implantation [ 9 ]. This could indicate the need for aggressive treatment and intensive monitoring.…”

Persistent Complete Heart Block in a Patient with COVID-19 Infection: a Case Report

“…A study in Wuhan reported the frequency of acute myocardial damage about 7.2% and cardiac arrhythmias about 16.7%. However, severe bradyarrhythmias such as third-degree atrioventricular block (AVB) have been relatively uncommon [ 2 ]. Herein, we have described the clinical presentation of advanced AVB in a patient with uncomplicated COVID-19 infection, which persisted over 4 weeks without hemodynamic instability.…”