Bradyarrhythmia in COVID-19 Patients

Abstract

The emergence of coronavirus disease 2019 (COVID-19) in 2019 has rapidly become a global health emergency. COVID-19 develops from a severe acute respiratory syndrome coronavirus (SARS-CoV) infection, which directly impacts the cardiovascular system by disrupting angiotensin-converting enzyme-2 receptors in the tissues. This leads to severe complications that cause major morbidity and mortality. Several cardiovascular complications have been reported during the pandemic, including myocardial infarction, stroke, pulmonary embolism, myocarditis, and tachyarrhythmias. Although bradyarrhythmia is another cardiac event associated with COVID-19, it has been reported in only a few cases in the medical literature. Here, we report two cases of young adult patients who were admitted because of a positive reverse transcriptase-polymerase chain reaction test of SARS-CoV-2 and presented with bradycardia detected on electrocardiogram but had an otherwise normal health condition with no history of cardiovascular illness.

A Slow Beat and a Dizzying Feat: COVID-19 Related Bradyarrhythmia

“…Like the mice, all four patients from the study had elevation of inflammation markers during their bradycardia. There is prior evidence that IL-6, which produces inflammatory markers, can directly act on the sinoatrial (SA) node and cause arrhythmias [7,9].…”

“…For further evidence, the National Commission of China reported that 11.8% of the infected patient population passed away with elevated levels of cardiac troponin I (cTnI) or cardiac arrest with pre-existing cardiovascular (CVS) comorbidities[1,6]. The cardiac manifestations have been diverse ranging from chest pain, palpitations to myocarditis, myocardial infarction, and decompensated ACS and arrhythmias[7]. The cardiac syndromes have been presented in different age populations, and in patients with different health profiles.…”

“…Cardiac arrhythmias in association with COVID-19 have been especially difficult to pinpoint in patients due to the transient and often silent nature of the symptom. Only 7% of patients reported in a study conducted by Liu et al presented with palpitations as a presenting symptom[7]. This has made it difficult to predict the likelihood of cardiac arrhythmias in a patient with COVID-19, therefore making it necessary to further study the pathophysiology of the virus on cardiac pacemaker cells and the complications.…”

Acute Cardiovascular Complications of COVID-19: A Systematic Review

“…Conduction abnormalities were another commonly reported arrhythmia [ 11 , 23 , 77 , 84 , 85 , 88 ]. In a case by Lalani et al, 45.6% of 730 patients developed prolonged QTc interval, while 24.2% developed sinus tachycardia [ 11 ].…”