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Case Reports
. 2020 Jul 30;4(FI1):1-6.
doi: 10.1093/ehjcr/ytaa238. eCollection 2020 Oct.

A case report of unusually long episodes of asystole in a severe COVID-19 patient treated with a leadless pacemaker

Ivan Cakulev  1 , Jayakumar Sahadevan  2 , Mohammed Najeeb Osman  1   2
Affiliations
Case Reports

A case report of unusually long episodes of asystole in a severe COVID-19 patient treated with a leadless pacemaker

Ivan Cakulev et al. Eur Heart J Case Rep. .

Abstract

Background: Experience has been emerging about cardiac manifestations of COVID-19-positive patients. The full cardiac spectrum is still unknown, and management of these patients is challenging.

Case summary: We report a COVID-19 patient who developed unusually long asystolic pauses associated with atriventricular block (AV) block and atrial fibrillation who underwent leadless pacemaker implantation.

Discussion: Asystole may be a manifestation of COVID-19 infection. A leadless pacemaker is a secure remedy, with limited requirements for follow-up, close interactions, and number of procedures in a COVID-19 patient.

Keywords: Asystole; Atrial fibrillation; Atrioventricular block; COVID-19; Case report; Leadless pacemaker.

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Figures

Figure 1
Figure 1
(A) Chest X-ray showing patchy areas of bilateral airspace opacities. (B) Computed tomography scan of the chest showing multifocal bilateral areas of ground-glass air space disease and consolidation consistent with the diagnosis of COVID-19. Approximately 35–40% of the lung appears to be involved. ART, arterial line.
Figure 2
Figure 2
(A) Twelve-lead ECG showing acute ST-segment depressions in the precordial and lateral leads. (B) Follow-up ECG showing an increase in the R/S ratio in leads V1 and V2 suggestive of evolving posterior wall myocardial infarct. (C) Initial coronary angiogram showing acute total occlusion of the LCx artery. (D) Deployment of a drug-eluting stent in the LCx artery. (E) Final angiogram showing full patency in the LCx artery post-stent deployment. ART, arterial line.
Figure 3
Figure 3
(A) Normal sinus rhythm at 83 b.p.m. preceding the pause. (B) Onset of the pause with slowing of the sinus rate for three cycles. (C) Part of the body of the pause. Duration of the pause between the arrows of 16 s. (D) Return rhythm of atrial fibrillation after the pause. ART, arterial line.
Figure 4
Figure 4
The leadless pacemaker Micra™ VR (Medtronic, Minneapolis MN, USA) in its final position on the septal wall of the right ventricle.
None
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