Novel coronavirus 19 (COVID-19) associated sinus node dysfunction: a case series

Abstract

Background: Novel coronavirus-19 disease (COVID-19) is associated with significant cardiovascular morbidity and mortality. To date, there have not been reports of sinus node dysfunction (SND) associated with COVID-19. This case series describes clinical characteristics, potential mechanisms, and short-term outcomes of COVID-19 patients who experience de novo SND.

Case summary: We present two cases of new-onset SND in patients recently diagnosed with COVID-19. Patient 1 is a 70-year-old female with no major past medical history who was intubated for acute hypoxic respiratory failure secondary to COVID-19 pneumonia and developed new-onset sinus bradycardia without a compensatory increase in heart rate in response to relative hypotension. Patient 2 is an 81-year-old male with a past medical history of an ascending aortic aneurysm, hypertension, and obstructive sleep apnoea who required intubation for COVID-19-induced acute hypoxic respiratory failure and exhibited new-onset sinus bradycardia followed by numerous episodes of haemodynamically significant accelerated idioventricular rhythm. Two weeks following the onset of SND, both patients remain in sinus bradycardia.

Discussion: COVID-19-associated SND has not previously been described. The potential mechanisms for SND in patients with COVID-19 include myocardial inflammation or direct viral infiltration. Patients diagnosed with COVID-19 should be monitored closely for the development of bradyarrhythmia and haemodynamic instability.

Keywords: Bradycardia; COVID-19; Case series; SARS-CoV-2; Sinus node dysfunction.

Figure 1

Patient 1 ECG demonstrating new-onset sinus bradycardia.

Figure 2

Patient 2 ECG from 30 months prior to hospitalization (A) demonstrating normal sinus rhythm with first-degree AV block and premature atrial complexes. The patient’s ECG during his hospitalization for COVID-19 (B) demonstrates new-onset sinus bradycardia, stable advanced interatrial block, new inferolateral T wave inversions, progressive first-degree heart block, and stable left anterior fascicular block.

Figure 3

Telemetry from Patient 2 demonstrating interval development of accelerated idioventricular rhythm with isorhythmic atrioventricular dissociation and a single fusion beat.