Setting and patient details/history:
In December 2019, SARS-CoV-2, a new strain of coronavirus was
identified in Wuhan, China. By March of 2020, the World Health
Organization (WHO) declared the COVID-19 outbreak a pandemic. According
to the WHO as of February 7, 2022, 410,565,868 cumulative cases of
COVID-19 infection have been confirmed with 5,810,88 deaths worldwide.
As of February 14, 2022, 77,707,349 had confirmed COVID-19 infection in
the United States with 919,255 deaths.
While the symptoms of COVID-19 can vary the most common symptoms,
including fever, dry cough, and occasionally diarrhea, usually develop
within 2 to 14 days of exposure. [1] An early study on clinical
characteristics of COVID-19 patients from Wuhan, China reported that the
primary infection develops in the respiratory tract with resulting
complications being predominantly acute respiratory distress and
secondly arrhythmias, experienced in 44% of patients requiring
intensive care. [2] While respiratory complications are the main
clinical manifestation of COVID-19, cardiovascular issues including
thromboembolic events, myocarditis, and pericarditis are not uncommon.
Cardiac injury has been reported in 19.7% of patients during
hospitalization. [3,4]
Cardiac arrhythmias are common in patients with COVID-19 infection. It
appears to be related to direct injury due to COVID-19 infection and the
multi-organ injury leading to arrhythmias. Adverse reactions to multiple
drugs used in critically ill patients with COVID-19 infection also play
a role in the occurrence of cardiac arrhythmias. A recent large study
of 700 patients with COVID-19 receiving intensive care revealed 9
cardiac arrests, 9 bradyarrhythmias, 25 incident atrial fibrillation,
and 10 non-sustained ventricular arrhythmias [5]. The occurrence of
cardiac arrests was associated with an increase in mortality.
The occurrence of bradycardia in patients with COVID-19 infection is not
uncommon. A retrospective case series of four patients with significant
bradycardia revealed mostly sinus bradycardia occurring after 9 to 15
days post-admission. [6] All four patients were treated sometime
during their stay with propofol and during bradycardia and 3 patients
were receiving corticosteroid therapy. The etiology of transient sinus
bradycardia is multifactorial needing increasing awareness. There have
been case reports of patients developing cardiac conduction
abnormalities in the setting of COVID-19 but there have been no reports
of patients experiencing permanent AV block and only a few reports of
young patients developing transient or lesser degrees of AV block.
[1-3,7-11] In this case, we present a young patient hospitalized
with COVID-19 who was found to have symptomatic bradycardia secondary to
permanent third-degree atrioventricular (AV) heart block. The case is
presented without identifier and based on IRB, consent is waved.