SINUS BRADYCARDIA AS THE INITIAL MANIFESTATION OF COVID-19

Background

While arrhythmias in general are now a well recognized complication of COVID-19, there are only few publications on bradycardia in COVID-19, generally secondary to drugs or some complications and none on primary bradycardia preceding clinical manifestations including respiratory symptoms or fever. We sought to describe a case series of sinus bradycardia as an initial manifestation of COVID-19

Methods

We included a series of 39 consecutive patients with confirmed COVID-19, who developed sinus bradycardia with a heart rate slower than 60 beats per minute in adults or a heart rate measured in the awake state that was below the normal range for age for children, as an initial manifestation of the disease, in a prospective observational multicenter study. Patients underwent clinical, laboratory evaluation, ECG, Holter, telemetry, Echocardiogram, Chest X Ray, chest CT scan and cardiac MRI.

Results

Thirty nine (39) patients were included, 29 (69%)were male 30 adults and 9 children(21%) with a median age 56,5(IQR18-66) range 4 months to 80 years, who were admitted for symptomatic bradycardia, the majority (35) transient and not severe .4 cases developed presyncope that amerited the intravenous administration of atropine 0,5 mg. Two of them with a paradoxical response with cardiac arrest that did not respond to cardiopulmonary resuscitation maneuvers and died.37 cases developed respiratory manifestation including 13 with pneumonia .37 patients survived and recovered without requiring mechanical ventilation.

Conclusion

Sinus bradycardia may be the initial manifestation of COVID-19, usually transient and mild, but in some cases could be severe and fatal (5%). Physicians should be aware of this presentation.