Syncope Associated with Sinus Nodal Dysfunction in a COVID-19 Patient: A Case Report and Review of the Literature

Abstract

COVID-19 caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is associated with significant cardiovascular dysfunction in patients with, and without, pre-existing cardiovascular disease [ 1 ]. There are now well-documented cardiac complications of COVID-19 infection which include myocarditis, heart failure, and acute coronary syndrome [ 2 ]. There is growing evidence showing that arrhythmias are also one of the major complications of COVID-19. We report a patient with no known cardiac conduction disease who presented with syncope, positive SARS-CoV-2 PCR, who was persistently bradycardic and subsequently developed sinus node dysfunction (SND). To date, there are a limited number of reports of sinus node dysfunction (SND) associated with COVID-19. We describe the clinical characteristics, potential pathophysiologic mechanisms and management of COVID-19 patients who experienced de novo SND.

Syncope and COVID-19 disease – A systematic review

“…The majority of studies, 16, described syncopal episodes of unexplained etiology (Romero-Sánchez et al, 2020, Pérez et al, 2020, Chachkhiani et al, 2020, Xiong et al, 2020, Radmanesh et al, 2020, Chuang et al, 2021, Pérez et al, 2020Mizrahi et al, 2020, Martín-Sánchez et al, 2020, Travi et al, 2020, Argenziano et al, 2020, Gonfiotti et al, 2020, García-Moncó et al, 2020, Chen et al, 2020, Lam et al, 2020, Chou et al, 2021. 10 case reports alluded to possible cardiac etiology for syncope (Sang et al, 2020, Pasquetto et al, 2020, Luetkens et al, 2020, Chang et al, 2020, Khan et al, 2020, Chalela et al, 2020, Chibane et al, 2020, Pendower et al, 2020, Aoi et al, 2020, Doodnauth et al, 2021 as well as 1 case series (Espinoza et al, 2021), while another 6 studies attributed the cause of syncope to orthostatic hypotension (Ebrille et al, 2020, Tapé et al, 2013, Logmin et al, 2020, Singhania et al, 2020, Huang et al, 2020, Omotosho et al, 2021. In turn, reflex syncope was highlighted in only 3 of the studies (Ebrille et al, 2020, Canetta et al, 2020, Birlutiu et al, 2020.…”

“…Of the 37 included articles, 18 were case reports (Tapé et al, 2013, Sang et al, 2020, Pasquetto et al, 2020, Luetkens et al, 2020, Logmin et al, 2020, Chang et al, 2020, Singhania et al, 2020, Huang et al, 2020, Omotosho et al, 2021, Khan et al, 2020, Chalela et al, 2020, Pérez et al, 2020, Chibane et al, 2020, Pendower et al, 2020, Aoi et al, 2020, Doodnauth et al, 2021, Kanjwal et al, 2020, Miglis et al, 2020, 10 were retrospective analyses (Oates et al, 2020, Romero-Sánchez et al, 2020, Chachkhiani et al, 2020, Xiong et al, 2020, Radmanesh et al, 2020, Canetta et al, 2020, Chuang et al, 2021, Mizrahi et al, 2020, Martín-Sánchez et al, 2020, Travi et al, 2020, 5 were case-series (Ebrille et al, 2020, Birlutiu et al, 2020, Argenziano et al, 2020, Espinoza et al, 2021, Gonfiotti et al, 2020 and 2 were prospective studies (García-Moncó et al, 2020, Chen et al, 2020. One was a letter (Lam et al, 2020).…”

“…Regarding the comorbidities of patients with COVID-19 and syncope, arterial hypertension was heavily represented in 21 studies (Oates et al, 2020, Ebrille et al, 2020, Romero-Sánchez et al, 2020, Tapé et al, 2013, Sang et al, 2020, Singhania et al, 2020, Pérez et al, 2020, Aoi et al, 2020, Doodnauth et al, 2021, Chachkhiani et al, 2020, Canetta et al, 2020, Chuang et al, 2021, Mizrahi et al, 2020, Martín-Sánchez et al, 2020, Travi et al, 2020, Birlutiu et al, 2020, Argenziano et al, 2020, Espinoza et al, 2021, Gonfiotti et al, 2020, García-Moncó et al, 2020, Lam et al, 2020, making it the most prevalent comorbid condition exhibited by the participants. This was followed by Diabetes mellitus, obesity, dyslipidemia and heart disease.…”

“…Out of the 18 case reports, syncope was the reason that prompted the visit to the Emergency Department in 13 of them (72.2%) (Tapé et al, 2013, Pasquetto et al, 2020, Luetkens et al, 2020, Logmin et al, 2020, Chang et al, 2020, Singhania et al, 2020, Huang et al, 2020, Chalela et al, 2020, Pérez et al, 2020, Chibane et al, 2020, Pendower et al, 2020, Aoi et al, 2020, Doodnauth et al, 2021. Furthermore, Ebrille et al (2020), Canetta et al (2020) and Espinoza et al (2021) also described syncope as the presenting symptom of the infection.…”

“…Considering confirmed or presumable cardiac syncope, the 13 reported cases included myocarditis (Luetkens et al, 2020), pulmonary embolisms (Khan et al, 2020, Chalela et al, 2020, Chibane et al, 2020, Pendower et al, 2020, Aoi et al, 2020 and ventricular fibrillation (Sang et al, 2020), Brugada Syndrome (Chang et al, 2020, Pasquetto et al, 2020, new onset atrial fibrillation together with anterior wall ST elevation myocardial infarction (Oates et al, 2020), sinus node dysfunction (Doodnauth et al, 2021), non-sustained tachycardia (Espinoza et al, 2021) and sinus bradycardia (Espinoza et al, 2021) as the underlying conditions.…”