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Prevalence of bradyarrhythmias needing pacing in COVID-19

Zaki Akhtar1,2, Lisa Wm Leung1, Christos Kontogiannis1

  • 1Cardiology, St George's University Hospital NHS trust, London, UK.

Pacing and Clinical Electrophysiology : PACE
|July 9, 2021
PubMed

Insights

The COVID-19 pandemic did not alter the prevalence of high-degree atrioventricular block, a type of bradyarrhythmia. Pacemaker implants for bradyarrhythmia were lower during the pandemic, with no cases of transient atrioventricular block linked to Sars-Cov-2 infection.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Public Health

Background:

  • Severe Acute Respiratory Syndrome-Coronavirus-2 (Sars-Cov-2) infection, the cause of COVID-19, is a multisystem illness impacting the cardiovascular system.
  • While tachyarrhythmias are reported, the prevalence of bradyarrhythmia, including high-degree atrioventricular (AV) block, in COVID-19 patients remains unclear.
  • Transient high-degree AV block has been described in some COVID-19 cases, often managed conservatively.

Purpose of the Study:

  • To investigate the prevalence of high-degree atrioventricular block requiring pacemaker implantation during the COVID-19 pandemic.
  • To compare pacemaker implantation rates for bradyarrhythmia during the first year of the pandemic versus the preceding year.
  • To determine if Sars-Cov-2 infection is associated with transient high-degree AV block.

Main Methods:

  • A retrospective analysis of patients requiring temporary or permanent pacemaker implantation in two cardiac centers.
  • Comparison of pacemaker procedures during the initial year of the COVID-19 pandemic with the corresponding period in the prior year.
  • Cross-referencing pacemaker databases with COVID-19 testing results to identify infected patients requiring pacing.

Main Results:

  • The total number of new pacemaker implants decreased during the pandemic year (540) compared to the previous year (629).
  • The proportion of high-degree AV block among new implants remained similar between the two periods (38.3% vs. 33.2%, p=0.069).
  • Six patients with Sars-Cov-2 infection required pacemaker implantation for bradyarrhythmia (four for high-degree AV block, two for sinus node dysfunction); two died from COVID-19, and one from sepsis.

Conclusions:

  • The prevalence of high-degree AV block requiring pacemaker implantation was not altered by the COVID-19 pandemic.
  • No evidence of transient high-degree AV block specifically associated with Sars-Cov-2 infection was found in this study.
  • Clinically significant bradyarrhythmia should be managed with pacing according to established protocols, irrespective of COVID-19 status.
Abstract

Keywords:
COVID-19bradycardiahigh-degree AV blockpacing

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