Prevalence of bradyarrhythmias needing pacing in COVID‐19

Abstract

Background The Sars‐Cov‐2 infection is a multisystem illness that can affect the cardiovascular system. Tachyarrhythmias have been reported but the prevalence of bradyarrhythmia is unclear. Cases have been described of transient high‐degree atrioventricular (AV) block in COVID‐19 that were managed conservatively. Method A database of all patients requiring temporary or permanent pacing in two linked cardiac centers was used to compare the number of procedures required during the first year of the pandemic compared to the corresponding period a year earlier. The database was cross‐referenced with a database of all patients testing positive for Sars‐Cov‐2 infection in both institutions to identify patients who required temporary or permanent pacing during COVID‐19. Results The number of novel pacemaker implants was lower during the COVID‐19 pandemic than the same period the previous year (540 vs. 629, respectively), with a similar proportion of high‐degree AV block (38.3% vs. 33.2%, respectively, p = .069). Four patients with the Sars‐Cov‐2 infection had a pacemaker implanted for high‐degree AV block, two for sinus node dysfunction. Of this cohort of six patients, two succumbed to the COVID‐19 illness and one from non‐COVID sepsis. Device interrogation demonstrated a sustained pacing requirement in all cases. Conclusion High‐degree AV block remained unaltered in prevalence during the COVID‐19 pandemic. There was no evidence of transient high‐degree AV block in patients with the Sars‐Cov‐2 infection. Our experience suggests that all clinically significant bradyarrhythmia should be treated by pacing according to usual protocols regardless of the COVID status.

Characteristics of bradyarrhythmia in patients with COVID‐19: Systematic scoping review

“…Table 2 presents the baseline demographics, diagnostic findings, and chief features of COVID‐19 patients who developed bradycardia from the individual cases compiled ( n = 59) 21–52 . Bradycardia predominated in male patients ( n = 37) with a median age of 58.0 years old (IQR 48.0−71.0).…”

“…Table 2 presents the baseline demographics, diagnostic findings, and chief features of COVID‐19 patients who developed bradycardia from the individual cases compiled ( n = 59). 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 Bradycardia predominated in male patients ( n = 37) with a median age of 58.0 years old (IQR 48.0−71.0). Bradycardia was most often observed in patients classified as having severe or critical illness COVID‐19 (35.6% and 32.2%, respectively).…”

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 ].…”

COVID-19 and Cardiac Arrhythmias: a Contemporary Review

“…The incidence of AV block in COVID-19 patients varies from 1–12% and is usually transient in nature [ 31 ]. These can manifest as high-grade second-degree AV block, such as Mobitz II second-degree AV block or 2:1 AV block, which may progress to intermittent complete heart block [ 32 , 33 ]. Many of these patients do not have pre-existing cardiovascular disease or abnormalities on prior echocardiograms, and clinicians need to be aware of the association between acute COVID-19 infection and transient AV block.…”