Brady‐arrhythmias in Patients with COVID‐19: Marker of Poor Prognosis?

Chinitz, Jason S.; Goyal, Rajat; Harding, Melissa; Veseli, Granit; Gruberg, Luis; Jadonath, Ram; Maccaro, Paul; Gandotra, Puneet; Ong, Lawrence; Epstein, Laurence M.

BACKGROUND: Despite descriptions of various cardiovascular manifestations in patients with COVID‐19, there is a paucity of reports of new onset brady‐arrhythmias, and the clinical implications of these events are unknown. METHODS: Seven patients presented with or developed severe brady‐arrhythmias requiring pacing support during the course of their COVID‐19 illness over a six‐week period of peak COVID‐19 incidence. A retrospective review of their presentations and clinical course was performed. RESULTS: Symptomatic high degree heart block was present on initial presentation in 3 of 7 patients (43%), and 4 patients developed sinus arrest or paroxysmal high degree AV block. No patients in this series demonstrated left ventricular systolic dysfunction or acute cardiac injury, whereas all patients had elevated inflammatory markers. In some patients, brady‐arrhythmias occurred prior to the onset of respiratory symptoms. Death from complications of COVID‐19 infection occurred in 57% (4/7) during the initial hospitalization, and in 71% (5/7) within three months of presentation. CONCLUSIONS: Despite management of bradycardia with temporary (3/7) or permanent leadless pacemakers (4/7), there was a high rate of short‐term morbidity and death due to complications of COVID‐19. The association between new‐onset brady‐arrhythmias and poor outcomes may influence management strategies for acutely ill patients with COVID‐19. This article is protected by copyright. All rights reserved