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. 2022 Feb 23;9(2):003026.
doi: 10.12890/2022_003026. eCollection 2022.

The Management of Acute Onset Complete Heart Block and Atrial Flutter in a Patient with COVID-19

Murtaza Hussain  1 , Dominic Awuah  1 , Smit Deliwala  1 , Mohammed Luay Alkotob  2 , Elfateh Seedahmed  3 , Ghassan Bachuwa  1
Affiliations

The Management of Acute Onset Complete Heart Block and Atrial Flutter in a Patient with COVID-19

Murtaza Hussain et al. Eur J Case Rep Intern Med. .

Abstract

Coronavirus disease (COVID-19) has infected millions of people worldwide. Its cardiac presentations include myocarditis, arrhythmias and structural heart changes even in young and healthy individuals. The long-term sequelae of these manifestations are unknown. We describe a unique combination of complete heart block and atrial flutter in the setting of COVID-19. SARS-CoV-2 virulence mechanisms can cause fibrosis in the myocardium resulting in loss of sinus node dominance. The paradoxical finding of atrial flutter and complete heart block is very rare. Prompt cardiac evaluation and electrophysiological testing are important. Cardiac magnetic resonance imaging (cMRI) and endomyocardial biopsies are the gold standard investigations. Anticoagulation should be administered until atrioventricular synchrony is achieved.

Learning points: Simultaneous atrial flutter and third-degree atrioventricular block (AVB) caused by COVID-19 infection should be treated with a pacemaker according to heart block guidelines.During the COVID-19 pandemic, we recommend leadless pacemaker implantation for third-degree AVB as it has a lower risk of infection compared with traditional percutaneous procedures.Due to a lack of long-term data, patients with cardiac manifestations from COVID-19 require close follow-up with individualized surveillance schedules.

Keywords: COVID-19; Complete heart block; atrial flutter.

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Conflict of interest statement

Conflicts of Interests: The authors declare there are no competing interests.

Figures

Figure 1
Figure 1
Atrial flutter with complete heart block and escape junction rhythm on electrocardiography (ECG)
Figure 2
Figure 2
Computed tomography (CT) of the head revealing a subacute left superior cerebellar infarct (arrow)
Figure 3
Figure 3
Evolving ground-glass opacity in the left upper lobe on computed tomography (CT) of the lung (arrowhead)
Figure 4
Figure 4
Computed tomography (CT) of the abdomen revealing two low-density areas in the left kidney consistent with renal infarcts (arrow)extremities
Figure 5
Figure 5
Severely dilated right atrium and moderately dilated left atrium on transthoracic echocardiography (TTE)
See this image and copyright information in PMC

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