A Rare Case: High-grade AV block in suspected COVID-19 Myoca
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In the ongoing pandemic of COVID-19, respiratory failure has been reported as the main cause of death in those who develop critical illness. A few cases of concurrent myocarditis have been reported, but the extent of cardiac complications with the SARS-CoV-2 strain of coronavirus is still largely unknown.

A 53-year-old man, suspected to have COVID-19 due to a new-onset cough, shortness of breath, and hypoxia, was referred to Cardiology with sudden symptomatic bradycardia. Initial rhythm analysis revealed Type 2 atrioventricular block (Mobitz II). On arrival at the coronary care unit, he was found to be in complete heart block (Type 3). Routine blood tests showed no elevation in troponin-I levels. Echocardiography showed mild impairment in left ventricular systolic function, with no regional wall motion abnormalities or valvular lesions. He then developed high-degree AV block lasting 6.2 s, prompting the need for an urgent permanent pacemaker implantation. As his respiratory symptoms had resolved, a PPM enabled to discharge him the next day and minimize further risk of exposure for the healthcare staff.

During the procedure, the Wenckebach point was noted to be 75 b.p.m. He was discharged within 24 h with advice to isolate as per the national guidelines. Follow-up at 6 weeks showed pacing dependence with more than 95% V-pacing and 6.1% A-pacing.

It is important to monitor cardiac status in affected patients, and address the possibility of cardiac involvement in the absence of significant troponin rise.

source: https://academic.oup.com/ehjcr/advance-article/doi/10.1093/ehjcr/ytaa248/5896829?rss=1