Complete AV Block in Vaccinated COVID-19 Patient

Abstract

Background. Coronavirus 2019 (COVID-19) was initially identified approximately in December 2019 at Wuhan, China, as patients presented with vague prodromal and respiratory symptoms. With the developing investigation of its clinical manifestation, cardiac symptoms have been widely reported including acute coronary syndromes, myocarditis, arrhythmias, heart failure, and cardiac arrest. Case Summary. An 84 year-old male with history of coronary artery disease, hypertension, and hyperlipidemia presented to an outside urgent care with prodromal symptoms. The patient had received the second Pfizer vaccine three months prior. This presentation, he was found to be COVID-19 positive as well as bradycardic with a complete AV block. He was transferred to a tertiary center for further evaluation and management. However, after transfer, the patient refused further invasive cardiac interventions and after medical therapy was discharged home in complete AV block. Discussion. We report a novel case of a Pfizer-vaccinated patient whose initial presenting symptoms of COVID-19 included a complete AV block as well as the challenges and difficulties in approaching such patients. Although this patient’s etiology of his complete AV block may result from multiple factors, given the acuity in setting of concurrent COVID-19 infections, top differentials include viral myocarditis, COVID-19-induced Takotsubo cardiomyopathy complicated by a complete AV-block, or a direct conduction pathway infection. Management of patients should focus on a multidisciplinary approach, and prevention is critical via vaccination.

Sudden Occurrence of Pacemaker Capture Failure during Irreversible Electroporation Ablation for Prostate Cancer in Post-COVID-19 Patient: A Case Report

“…The intraoperative management of heart disease patients with a COVID-19 infection history (ongoing infectious phase or postinfectious recovery phase) has not been clearly determined yet, but COVID-19 infection may possibly contribute to the deterioration of the cardiac conduction system, such as sinus node disease or high degree AV block [ 23 , 24 ]. Cardiac electrophysiologic therapy has continuously played a reliable role to help COVID-19 patients recover from fatal arrhythmia despite the concerns of difficult lead positioning, health care providers safety, and the reduction of de novo implantation [ 25 ].…”

Takotsubo syndrome and vaccines: a systematic review

“…One hundred fourteen studies were further excluded after screening for title and abstract. Of the remaining 25 articles, four studies focused on complications other than vaccination, [20][21][22][23] one study focused on non-TTS cardiac complications after vaccination, 24 and two studies were not case reports or case series. 25,26 Those studies were excluded as a result.…”

SARS-CoV-2 infection is associated with anti-desmoglein 2 autoantibody detection

“…Cardiac injury following COVID-19 infection is now well described in the literature, although the mechanisms behind this remain uncertain (7). Clinical studies have reported post-covid complications such as thromboembolism, ischaemia, arrhythmias, conduction defections and myocarditis (18)(19)(20) and post-mortem studies have found increased neutrophil extracellular trap (NET) formation and mononuclear cell infiltration (9). Given that cardiac involvement is an important and long-term consequence of COVID-19, and potential also within the spectrum of syndromes observed in "long-COVID", we examined post-mortem heart tissue for DSG2 protein.…”