Pacemaker implantation for persistent sinus node dysfunction in a patient with COVID-19

Area of Science:

• Cardiology
• Infectious Diseases
• Critical Care Medicine

Background:

• Coronavirus disease-2019 (COVID-19) is a global pandemic with diverse clinical manifestations.
• Cardiac complications, including arrhythmias and heart failure, have been reported in COVID-19 patients.
• Sinus bradycardia is an uncommon but significant cardiac finding in the context of severe infections.

Observation:

• A 46-year-old woman with COVID-19 presented with symptomatic sinus bradycardia.
• The bradycardia progressed, leading to congestive heart failure.
• Standard medical therapies (isoproterenol, theophylline, cilostazol) were ineffective and deemed unsafe.

Findings:

• The patient required permanent pacemaker implantation 53 days after initial admission.
• Atrial pacing was utilized, with 60% pacing noted at the 6-month follow-up.
• This case illustrates a severe, refractory bradyarrhythmia secondary to COVID-19 infection.

Implications:

• COVID-19 can precipitate severe cardiac dysfunction, including persistent bradycardia requiring device implantation.
• Careful cardiac monitoring and management are crucial for patients with COVID-19 and cardiac symptoms.
• This case underscores the need for considering advanced cardiac interventions in select COVID-19 patients with refractory arrhythmias.