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

Abstract

The pandemic of COVID-19 as a global concern has emerged the need for data aggregation about various clinical pictures particularly cardiovascular complications. Although the incidence of advanced atrioventricular block (AVB) in these patients is not well established, few cases have been reported. We have reported a 48-year-old man with COVID-19 infection who presented with prodromal symptoms for 5 days preceding complete AVB found at the emergency department. Pulmonary involvement and PCR confirmed the diagnosis. The block persisted after recovery of the patient for more than 1 month. Pathophysiology of advanced AVB following COVID-19 infection is not well understood. Several factors including inflammatory response, immune system over activity, myocarditis, and medications have been underlined. Although conservative management may lead to spontaneous recovery of AVB, pacemaker implantation is reasonable in case of persistent conduction defect.

Post-COVID-19 Syndrome: The Persistent Symptoms at the Post-viral Stage of the Disease. A Systematic Review of the Current Data

“…In addition to these symptoms in a prospective study by Cirulli et al symptoms such as difficulty concentrating, fatigue, memory loss, confusion, headache, heart palpitations, chest pain, pain with deep breaths, dizziness, and tachycardia were detected at 3 months of follow up (76). Fatigue, dyspnea, and heart dysfunctions in mild COVID-19 patients were also reported in several case-reports (69,72,80) at up to 8 months of follow-up. In addition, a case-report on three women also reported telogen effluvium, temporary hair shedding, as a long-term COVID-19 symptom 3 months after getting the infection (94).…”

“…D'Cruz et al and Taboada et al, analyzing prospectively two cohorts of 119 and 91 severe/critical COVID-19 patients, respectively, showed the presence of dyspnoea on exertion (57%), asthaenia (37%), myalgia (37%), and arthralgia (29%) up to 2 months after symptoms onset and a general decrease in quality of life (mobility, usual activities, self-care, pain/discomfort, anxiety/depression) in 67% of patients at up to 6 months of follow-up ( 77 , 100 ). However, these widespread long-term symptoms were not only present in severe COVID-19 patients, but also in patients who had mild and moderate disease ( 72 , 76 , 80 , 94 , 98 , 146 , 159 ). Carvalho-Schneider et al, in a prospective study on 150 mild/moderate COVID-19 patients at 2 months of follow-up, highlighted dyspnea and asthenia, respectively, in 30 and 40% of patients ( 74 , 98 ).…”

Conduction System Disease and Atrioventricular Block in Victims of COVID-19 in Iran

“…Among those with AV block, 12(2.8%) cases suffered from 3rd degree (Complete Heart Block). CHB has been assumed to be a rare ECG feature of COVID-19 and this novel nding was only been reported in a few case studies [5,7,9].…”

“…More recently, a growing body of literature on COVID-19 has investigated the electrophysiological issues presetting as a disease manifestation of COVID-19 and highlight the spectrum of arrhythmias observed in patients with COVID-19 infection [4]. Moreover, multiple case reports introduce atrioventricular block as a potential manifestation of COVID-19 [5][6][7][8][9][10][11][12][13]. In a retrospective study about the prognostic signi cance of electrocardiography ndings in patients with COVID-19, T-wave change (31.7%), QTc interval prolongation (30.1%), and arrhythmias (16.3%) were three most common found ECG abnormalities and atrioventricular block were presented in 3.9% of the patients [14].…”

Implantation of cardiac electronic devices in active COVID-19 patients: Results from an international survey

“… 5 , 6 , 7 , 8 , 9 , 10 There are only a few case reports and small case series in the literature of patients with COVID-19 who were implanted with a CIED while having active disease, and none reported procedural complications. 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 Active COVID-19 has implications for treating physicians and staff, and impacts CIED planning. The implanting physician and supporting staff need to wear personal protective equipment (PPE) during the procedure with possible impairment in their ability to perform the procedure.…”