ABSTRACT
In December 2019, a new single-stranded ribonucleic acid betacoronavirus (SARS-CoV-2) was observed in the People's Republic of China causing coronavirus disease 2019 (COVID-19) characterized by an acute respiratory distress syndrome (ARDS) (World Health Organization (WHO);Gonzalez Carta et al., 2021;The European Society for Cardiology;Nishiga et al., 2020). Subsequently, COVID-19 was declared a pandemic by the World Health Organization (WHO) on March 11th of 2020 (World Health Organization (WHO)). COVID-19 has had devastating global consequences for public health, the economy, and society (World Health Organization (WHO);Gonzalez Carta et al., 2021;The European Society for Cardiology;Nishiga et al., 2020;Mendoza et al., 2020). The predominant impact of COVID-19 is on the respiratory system, followed by Physiopathology of cardiovascular (CV) involvement which has significant prognostic implications. Individuals with underlying CV disease are at highest risk, including those with arterial hypertension and diabetes (Gonzalez Carta et al., 2021;The European Society for Cardiology;Nishiga et al., 2020;Mendoza et al., 2020). The global prevalence of reported CV complications in COVID-19 ranges between 12 and 78% of cases (Gonzalez Carta et al., 2021;The European Society for Cardiology;Nishiga et al., 2020;Mendoza et al., 2020). The mortality rate reported in patients with COVID-19 and previous CV diseases is significant (10.5%), and it is related to the presence of factors that alter the regulation of the immune system, such as older age or CV risk factors (Gonzalez Carta et al., 2021;The European Society for Cardiology;Nishiga et al., 2020;Mendoza et al., 2020). © 2022 Elsevier Inc. All rights reserved.
ABSTRACT
Background: There is growing evidence showing that arrhythmias are one of the major complications of COVID-19.However, there are currently only a few case reports of high-grade atrioventricular block (AVB). We sought to describe a large case series of AVB as a complication of COVID-19. Objective: The purpose of the current study is to describe a large case series of AVB as a complication of COVID-19. Methods: We included a series of twenty-five (25)consecutive patients with confirmed COVID-19, who developed advanced AVB in a prospective observational multi-center study. Patients underwent clinical, laboratory evaluation, Holter, telemetry, Echocardiogram, Chest X-Ray, chest CT scan and cardiac MRI Results: Of the 25 patients 13 were male with a mean age of 62+-13 years. 19 developed complete AVB, one a 3:1 AVB and five 2:1 AVB. None of the patients had a history of cardiac arrhythmia. AVB was not related to medication or intubation. Eighteen patients developed AVB during their hospitalization for COVID-19 and 7 after the first month as a late sequela. Five patients were asymptomatic, 6 presented syncope, seven dyspnea and seven dizziness. Eleven patients presented reverse AVB early by a high dose of corticosteroid in all of them, and combined with colchicine in 4 cases, with no recurrent episodes. 13 patients required a permanent pacemaker for persistent conduction defect (52%) and one died of ventricular fibrillation without pacemaker Conclusion: Advanced AVB could be a complication of COVID-19. The conduction disturbance was reversed by corticosteroids with or without colchicine in eleven of twenty five cases (44%)The resolution with corticosteroids of the advanced AVB in these patients could reflect the transient nature of the viral infection and the inflammatory response associated with it in some patients. 13 patients required a pacemaker(52%). Physicians should be aware of this complication.