COVID-19 Collection
Successful treatment of acquired heart block with ablation
Transient episodes of atrioventricular (AV) block may be due to vagal stimuli such as in neurocardiogenic syncope, paroxysmal AV block due to His/Purkinje disease, inflammation, infection, or injury. In this case, a unique explanation for episodic heart block is suggested, with successful treatment.Torsades de pointes following vaccination for COVID-19
Torsades de pointes is a polymorphic ventricular tachycardia that can cause syncope and lead to sudden cardiac death. This arrhythmia is initiated by early afterdepolarizations in the setting of prolonged ventricular repolarization, manifesting as QT prolongation on the 12-lead electrocardiogram (ECG).1 Common risk factors include QT-prolonging medications, electrolyte disturbances, bradycardia, and certain inherited genetic mutations.2 We report a case of torsades de pointes that occurred shortly after vaccination for COVID-19.Unmasked type 1 Brugada ECG pattern without a fever after a COVID-19 vaccination
Brugada syndrome (BrS) patients are regarded as a high-risk population under the COVID-19 pandemic because infection-induced fevers may unmask a type 1 Brugada electrocardiogram (ECG) pattern potentially leading to lethal ventricular arrhythmias.1 Vaccinations seem to be crucial in BrS patients; however, careful observation and antipyretic drugs are necessary for vaccine-induced fevers.2 Among the enormous number of COVID-19 vaccinations around the world, although the incidence is rare, death events, including sudden cardiac death, after a vaccination have been reported.Theophylline to treat prolonged paroxysmal complete atrioventricular block without conduction disorder or structural heart disease after COVID-19 infection: A case report
The novel coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a positive-sense, single-stranded RNA virus. The most common symptoms include cough, fever, fatigue, shortness of breath, sore throat, and headache. Although respiratory failure is the primary complication seen in COVID-19 patients, the cardiovascular system can also be targeted with complications, including myocardial injury, myocarditis, arrhythmias, heart failure, and acute myocardial infarction.Autonomic dysfunction post–acute COVID-19 infection
SARS-CoV-2 infection, which causes the disease COVID-19, is most known for its severe respiratory complications. However, a variety of extrapulmonary effects have since been described, with cardiovascular complications being among the most common.1 Those who recover from the acute phase of COVID-19 may be left with residual symptoms such as chest pain and dyspnea, resulting in a decreased quality of life and a syndrome sometimes described as “long COVID.”2 Recent evidence suggests that survivors with some of these chronic symptoms may have autonomic dysfunction (AD) with features of postural orthostatic tachycardia syndrome (POTS) and/or inappropriate sinus tachycardia (IST).Remdesivir-induced symptomatic bradycardia in the treatment of COVID-19 disease
Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, no antiviral medication to date has been proven to be beneficial except for remdesivir. With remdesivir being widely utilized in the treatment of COVID-19, many studies vouch for its overall safety profile.1 We report the first case of remdesivir-induced hemodynamically significant sinus node dysfunction that was resolved following completion of remdesivir therapy. The patient received remdesivir as an initial dose of 200 mg intravenously (IV) followed by maintenance dose of 100 mg IV for 4 days.Atypical presentation of COVID-19 as subclinical myocarditis with persistent high-degree atrioventricular block treated with pacemaker implant
The novel coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a positive-sense, single-stranded RNA virus.1 The most common presenting symptoms include cough, fever, fatigue, shortness of breath, sore throat, and headache. Although respiratory failure is the primary complication seen in COVID-19, patients are at high risk of having multisystem involvement, including acute cardiac injury.2 We present an atypical case of COVID-19 infection with subclinical myocarditis and intermittent complete atrioventricular (AV) block to demonstrate the value of cardiac magnetic resonance imaging (cMRI) in detecting early cardiac involvement.High-grade heart block requiring transvenous pacing associated with multisystem inflammatory syndrome in children during the COVID-19 pandemic
Multisystem inflammatory syndrome in children (MIS-C) has recently been described in pediatric patients associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the coronavirus disease 2019 (COVID-19) pandemic.1–3 Although MIS-C is commonly associated with cardiovascular findings, the occurrence of arrhythmias is rare. We present the case of a pediatric patient who developed severe hemodynamic instability and high-grade heart block associated with MIS-C, requiring transvenous pacing.Malignant ventricular arrhythmias in patients with severe acute respiratory distress syndrome due to COVID-19 without significant structural heart disease
Since December 2019, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has resulted in a pandemic of novel coronavirus (COVID-19) infections. Although predominantly a respiratory illness that can cause acute respiratory distress syndrome (ARDS), data suggest cardiovascular involvement contributes significantly to the disease’s mortality. Data from Wuhan, China, demonstrated patients with pre-existing cardiovascular disease and elevated troponin levels had 69.44% mortality.1Rhythm, conduction, and ST elevation with COVID-19: Myocarditis or myocardial infarction?
Coronavirus disease 2019 (COVID-19) caused by the coronavirus 2 (SARS-CoV-2) predominantly affects the respiratory system but may also result in cardiac complications, including myocarditis.1 SARS-CoV-2 binds to the angiotensin-converting enzyme-2 receptor expressed on the surface of alveolar and cardiac cells, which may account for the direct cardiac involvement in COVID-19.2 Myocarditis is an inflammatory disease caused by infectious and noninfectious etiologies.3 Fulminant myocarditis is the most severe type of myocarditis and is predominantly caused by viral infections.Electrical storm in a febrile patient with Brugada syndrome and COVID-19 infection
The eponymous syndrome first described by the Brugada brothers in the early 1990s consists of characteristic ST abnormalities and an increased risk of sudden cardiac death due to ventricular arrhythmias.1 Since that time, further genetic research has implicated hundreds of variants in 17 genes with mutations in SCN5A, coding for voltage-gated sodium channels, accounting for the majority of genotyped patients.2 Various triggers have been associated with the development of ventricular fibrillation (VF) in this patient population, including fever and alcohol intake.Heart block in patients with coronavirus disease 2019: A case series of 3 patients infected with SARS-CoV-2
In December 2019 a novel coronavirus, SARS-CoV-2, was identified as the pathogen causing coronavirus disease 2019 (COVID-19) in Wuhan, Hubei Province, China.1 By the end of January 2020, the World Health Organization declared the outbreak of SARS-CoV-2 a Public Health Emergency of International Concern.2 Respiratory illness remains the main clinical manifestation of COVID-19, but involvement of other systems, including the cardiovascular system, has been well documented. It is estimated that up to 19.7% of patients were noted to have cardiac injury, based on literature from Wuhan, China.Temperature monitoring with an implantable loop recorder in a patient with presumed COVID-19
The pandemic caused by novel coronavirus (SARS-CoV-2) has had an enormous impact on the health and economy of the entire world.1 The total numbers of cases and fatalities continue to rise and the mortality rate is currently estimated to be 1%–5%.2 Of the multiple symptoms and clinical findings that have been attributed to COVID-19 infection, fever and cough are the most common,3 and significance in terms of widespread screening has been defined as temperatures ≥100.5°F/38°C.4 Cardiac injury and cardiac mortality have also become part of the emerging clinical picture of COVID-19,4–6 and this raises the prospect of how to use implantable devices such as implantable cardiac monitors (ICMs) to aid in the screening or triage of suspected patients.A case of novel coronavirus (COVID-19)-induced viral myocarditis mimicking a Takotsubo cardiomyopathy
Currently, there is a paucity of data on the cardiac manifestations of the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We present a patient with coronavirus disease 2019 (COVID-19) pneumonia complicated by hypotension and cytokine storm, followed by viral myocarditis mimicking features of Takotsubo cardiomyopathy. Rapid improvement of cardiac function after treatment highlights the importance of obtaining early cardiac biomarkers and noninvasive imaging in this patient population.Medication unmasked Brugada syndrome and cardiac arrest in a COVID-19 patient
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in China in late 2019, and rapidly spread worldwide in the ongoing coronavirus disease (COVID-19) pandemic. Although it primarily affects the respiratory system, with severe cases leading to acute respiratory distress syndrome, COVID-19 is associated with cardiovascular complications including myocardial injury, myocarditis, and malignant arrhythmias. We describe a case of fever and medication unmasking of Brugada syndrome (BrS) and resulting polymorphic ventricular tachycardia (PMVT).Cardiac injury, arrhythmia, and sudden death in a COVID-19 patient
As the COVID-19 (coronavirus disease 2019) pandemic spreads globally, our knowledge about its myriad presentations continues to evolve. Here we present a case of a patient with COVID-19 who rapidly succumbed to death after presenting to the emergency room (ER) with apparent acute myocardial infarction (MI).EP News: Basic and Translational
Liu et al (Circulation April 15, 2020;doi:10.1161/CIRCULATIONAHA.120.047549, PMID 32293910) provided an overview of coronavirus disease 2019 (COVID-19) that is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The high infectivity of the SARS-CoV-2 virus is contributed by new mutations in the receptor-binding domain and acquisition of a furin cleavage site in the S spike protein. The virus uses the angiotensin-converting enzyme 2 (ACE2) receptor for cell entry, which is mediated by the host cell serine protease TMPRSS2.EP News: Case Reports
Coronavirus disease 2019 (COVID-19) is highly infectious and causes significant strains on health care systems. Routine testing within the hospital is weighed for needed value to minimize exposure to staff. The combination of hydroxychloroquine and azithromycin, both known to prolong the QT interval, was shown to lower the viral load, and early in the COVID-19 pandemic, the drugs were used to try to lower the morbidity and mortality of the infection. Gabriels et al (doi: https://doi.org/10.1016/j.hrcr.2020.03.017 ) shared a case of a 72-year-old woman with paroxysmal atrial fibrillation, treated with flecainide and metoprolol, who presented with dyspnea, cough, fevers, and chills.Syncope as the presenting symptom of COVID-19 infection
The severity of COVID-19 symptoms can range from none to very mild or severe. They usually appear 2 to 14 days after virus exposure and can include fever, cough, shortness of breath, headache, diarrhea, vomiting, runny nose, sore throat, anosmia and ageusia, conjunctivitis, tiredness, and aches.1 To our knowledge, syncope alone has not been described as a symptom associated with COVID-19 infection. We report a case series of syncope as the presenting symptom in otherwise asymptomatic patients with COVID-19 infection.EP News: Basic and Translational
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has been shown to be associated with a high inflammatory burden that can induce vascular inflammation, myocarditis, and cardiac arrhythmias. The current study by Hoffmann et al (Cell 2020;doi:10.1016/j.cell.2020.02.052; PMID 32142651) investigates the mechanisms of SARS-CoV-2 entry into mammalian cells. The spike (S) protein of coronaviruses facilitates viral entry into target cells by binding of the surface unit (S1) of the S protein to a cellular receptor, angiotensin-converting enzyme 2 (ACE2), as the entry receptor.EP News: Allied Professionals
In a departure from the usual format of review of 1 article followed by a discussion of 1 topic, given the unusual times, the discussion of 1 topic will predominate. There are already hundreds of articles with topics such as the cardiovascular manifestations of coronavirus disease (COVID-19), the increased risk to patients with preexisting cardiovascular disease, arrhythmias associated with infection, and proarrhythmic effects of proposed treatments to be found with a simple Google or PubMed search.EP News: Clinical
Lakkireddy et al (Heart Rhythm April 1, 2020; https://doi.org/10.1016/j.hrthm.2020.03.028 , PMID 32228309) summarized the available evidence and provided recommendations for electrophysiologists related to coronavirus 2019 (COVID-19) in a consensus document from the Heart Rhythm Society, American College of Cardiology, and American Heart Association. They noted that electrophysiologists, like all cardiologists and other health care workers, have been affected personally and professionally by this global catastrophe.EP News: Case Reports
The phenotype of Brugada syndrome is associated with a decrease in the sodium current and can manifest with sudden death in previously healthy individuals. Many triggers have been described, including fever, alcohol intake, and medications that cause sodium channel blockade. Coronavirus disease 2019 (COVID-19) most commonly presents with fever and a cough. Chang et al (doi: https://doi.org/10.1016/j.hrcr.2020.03.012 ) shared a case of a 49-year-old Bangladeshi man without a significant medical history who presented after an episode of syncope and fever.An algorithm for managing QT prolongation in coronavirus disease 2019 (COVID-19) patients treated with either chloroquine or hydroxychloroquine in conjunction with azithromycin: Possible benefits of intravenous lidocaine
The rapid spread of the coronavirus disease 2019 (COVID-19) pandemic owing to a newly identified coronavirus, SARS-CoV-2, originating in Wuhan, China, has resulted in significant morbidity and mortality around the world. Early reports have shown improved clinical outcome and viral clearance with the use of chloroquine and hydroxychloroquine.1,2Inpatient use of mobile continuous telemetry for COVID-19 patients treated with hydroxychloroquine and azithromycin
The current COVID-19 pandemic has placed extreme stress on the global health care system. Novel approaches to managing COIVD-19 patients are required. Preliminary results from a small trial suggest that a combination of hydroxychloroquine and azithromycin is efficacious for reducing the viral load in patients with COVID-19.1 Although the arrhythmogenic risk of these medications is low, both of these medications alone, and in combination, can prolong the QT interval.1–7 Patients receiving this regimen require, at a minimum, serial electrocardiograms (ECGs), which increases the risk of potential exposures for staff members and requires use of additional personal protective equipment.
