PREMATURE ATRIAL CONTRACTION REQUIRING ABLATION IN YOUNG PATIENT WITH COVID-19

Background:

COVID-19 has been linked to atrial arrhythmias. Clinical course of atrial arrhythmias is unknown following recovery from the virus.

Case:

After recovery from COVID-19 with supportive outpatient care, an otherwise healthy 26 year old female noted new onset palpitations—lasting several minutes, multiple times per week, for a few months. She established care with cardiology. Initial EKG showed frequent premature atrial contractions (PACs) (A). She was prescribed metoprolol as needed, but symptoms persisted. Metoprolol was scheduled and increased. Yet, severe symptoms continued. Holter monitor showed 21% PAC burden over 3 days. She was referred to Electrophysiology (EP) for further care.

Decision-making:

Untreated frequent PACs may lead to atrial fibrillation and cardiomyopathy. Initial therapy is beta blockers or calcium channel blockers. Metoprolol was not effective in this patient. Alternative antiarrhythmic agents were considered, but they carry risk of cumulative toxicities. Ultimately, given the patient's young age, antiarrhythmic drugs were not prescribed. Catheter ablation was pursued. EP study showed frequent focal PACs which were localized to two foci and ablated (B, C). At 2 week follow up, patient's symptoms completely resolved, with repeat Holter monitor showing <1% PAC burden.

Conclusion:

Catheter ablation for symptomatic PACs in patients with recovered COVID-19 is a reasonable approach for patients who continue to be symptomatic despite medical therapy.