Table 2.
Summary of studies of patients with bradyarrhythmia
| Study | Age (yr) | No. of patients | Arrhythmia | Condition related to SARS-CoV-2 | Past medical history | Clinical detail | Laboratory findings | Management | Outcome | Study type | Country |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Lara et al. [62] 2020 | 12 | 1 | Complete AVB | Acute COVID-19, fulminant myocarditis | Previously healthy | Cardiac arrest following severe bradycardia with complete heart block, and hypotension. De- creased LV EF 27% | Elevated BNP, and troponin I | Epinephrine, IVIG | NSR on HD 4, and improved LV function to normal | Case report | Louisiana, USA |
| El-Assaad et al. [86] 2020 May | 10 | 1 | First-degree AVB → complete AVB | Acute COVID-19, myocarditis | Pityriasis lichenoides chronica | Sinus tachy, severe LV dysfunction EF 32% → 1st degree AVB on HD 2. complete degree AVB and 2nd degree AVB on HD 3. | Elevated CRP, D- dimer, BNP, and high-sensitive troponin. | IVIG, anakinra, methylPd, remdesivir. no intervention for bradyarrhythmia | Spontaneously resolved | Case report | Boston, USA |
| Dionne et al. [56] 2020 August | Median 12.1 | 5/25 (20%) | First-degree AV block (n=5) → progressed to second- (n=3) or third- AVB (n=1) | MIS-C | NA | All had ventricular dys- function (LV EF 40%– 55% in 4, <40% in 1). Inotropics support d/t hypotension or shock in 4 patients | Elevated BNP (4/5), normal troponin (5) | No treatment required for the AVB. Inotropics for shock | NSR in all patients | Single center observational study | Boston, USA |
| Carmona et al. [59] 2021 October | 19 | 3 | 1st AVB with RBBB on admission → complete AVB → type 2nd-degree AVB type I 2nddegree AVB → first-degree AVB | MIS-C | Previously healthy | LV EF 40% improved to 50%. Cardiac MRI: sub- epicardial enhancement along the basal inferior wall | Hypotensive, elevated CRP, ESR, and BNP. Mildly elevated troponin | Isoproterenol for cAVB, IVIG, methylPd, azithromycin, Anakinra, tocilizumab | Discharge, normal LV function, persistent firstdegree AVB | Case report | Florida, USA |
| 9 | Sinus bradycardia on HD 8 with prolonged QTc 545 msec | MIS-C | Previously healthy | LV EF 35%–40%, hypotension | Mildly elevated troponin, elevated BNP, CRP | IVIG, methylPd, anakinra, inotropics | Discharged with normal QTc and normal LV EF | ||||
| 9 | RBBB on HD 4 (initially NSR → sinus bradycardia) | MIS-C | Obese | Inicial ormal LV function On HD 3, mild LV dysfunction with RBBB → junctional rhythm, sinus brady 38–48 bpm | Elevated BNP, IL- 6, lactic acid, and CRP. Normal troponin | IVIG, methylPd, anakinra | Discharged with NSR and normal LV function | ||||
| Domico et al. [63] 2020 | 11 | 1 | Sinus bradycardia with 1st and 2nd degree on HD 4 type II 2nd-degree AVB, nonspecific intraventricular conduction delay, nonsustained VT | MIS-C, giant aneurysm in coronary arterie | Previously healthy | Vasogenic shock, normal LV EF → intubation, inotropes → On HD 4, sinus brady with varying degree AV block (1st and 2nd degree) type II 2nd degree AVB | Elevated CRP, ESR, IL-6, and lactate. Serial troponin during admission: within normal range | Temporary transvenous pacing and methylPd, IVIG, infliximab | NSR. Complete recovery before discharge | Case report | Califonia, USA |
| Choi et al. [61] 2020 December | Median 11.5 (range 9–17) | 6/32 (19%) | First-degree AVB (n=6), RBBB (n=1) | MIS-C | NA | Onset of AVB: median 8 days after the initial symptom. No advanced AVB | Elevated CRP, IL- 6, NT pro-BNP, high-sensitive troponin T, LDH, D-dimer | No management for first-degree AVB, IVIG, methylPd, anakinra (13%) | NSR 3 days there after | obs. Study | New York, USA |
| Mehta et al. [64] 2021 | 6 | 1 | Complete AVB with a HR of 32 bpm on admission | MIS-C | Previously healthy | 4 Days after fever onset, Shock with HR 32 bpm with poor perfusion on admission. Mild LV dysfunction | Elevated CRP, LDH, NT pro-BNP, and tropoin I | Isoproterenol/adrenaline followed by temporary PM implantation. IVIG, methylPd, | NSR after 5 days. NSR during fol- lo w-up at 2 months after the illness | Case report | West Bengal, India |
| 7 | 1 | Complete AVB with HR of 26/min on admission | MIS-C | NA | 6 Days after fever onset, shock with HR 26 bpm on admission. mild LV dilatation and dysfunction | Elevated CRP, LDH, NT pro-BNP, and tropoin I | Isoproterenol/adrenaline followed by temporary PM implantation → no recovery for 12 days → permanent PM implantation | Permanent PM. Remained pace- maker dependent at 1 month of follow-up | |||
| Giordano et al. [87] 2021 | 14 | 1 | First-degree AVB | MIS-C | Previously healthy | Hypotensive shock | Elevated CRP, ESR, LDH, D-dimer, and troponin | IVIG, methylPd | Recovered to NSR | Case report | Italy |
| Di Filippo et al. [88] 2021 August | 12 | 1 | First-degree AVB | MIS-C | Previously healthy | Improved clincial condition after IVIG and methylPd, but on day 8 after fever worsening EF 53% with increased BNP, moderate MR and first-degree AVB appeared | Elevated CRP, Ddimer, IL-6, BNP, and troponin | IVIG, methypPd | 12 Days after fever, normal ECG and normal LV EF | Case report | Italy |
| Sisko et al. [89] 2021 October | 8 | 1 | Complete AVB with ventricular escaped beat 30 bpm | Chronic phase of COVID-19 (COVID-19 infection 4 months ago) | Previously healthy | Severe RV dysfunction, severe TR, abdominal pain, marked bradycardia, hepatomegaly | Normal CRP, ESR, and torponin I. Elevated BNP. Diffuse late gadolinium enhancement in RV free wall in MRI | Dopamine, milrinone, IVIG, methylPd, favipiravir, temporary PM implantation on HD#7 | Permanent PM implantation and TV repair on the 19th day on admission | Case report | Izmir, Turkey |
SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; AVB, atrioventricular block; COVID-19, coronavirus disease 2019; LV, left ventricular; EF, ejection fraction; BNP, brain natriuretic peptide; bpm, beat for minute; IVIG, intravenous immunoglobulin; NSR, normal sinus rhythm; HD, hospital day; CRP, C-reactive protein; methylPd, methylprednisolone; NA, not available; MIS-C, multisystem inflammatory syndrome in children; MRI, magnetic resonance imaging; ESR, erythrocyte sedimentation rate; cAVB, complete atrioventricular block; RBBB, right bundle branch block; IL-6, interleukin-6; ECG, electrocardiogram; MIS-C, giant aneurysm in coronary arteries; NT pro-BNP, N-terminal-pro-hormone brain natriuretic peptide; HR, heart rate; PM, pacemaker; LDH, lactate dehydrogenase; MR, mitral regurgitation: TR, tricuspid regurgitation; RV, right ventricular.