key: cord-0777919-ie45hjuu authors: Bhasin, Varun; Carrillo, MaryKate; Ghosh, Bobby; Moin, Danyaal; Maglione, Theodore J.; Kassotis, John title: Reversible complete heart block in a patient with coronavirus disease 2019 date: 2021-07-28 journal: Pacing Clin Electrophysiol DOI: 10.1111/pace.14321 sha: b1fd58caed78ea08f46bac3a5283ec9b393020b9 doc_id: 777919 cord_uid: ie45hjuu Patients infected with novel coronavirus (SARS‐CoV‐2) can present with a variety of arrhythmias. We report an unusual case of reversible complete heart block (CHB) in the setting of acute coronavirus disease 2019 (COVID‐19). A 23‐year‐old male with a history of Hodgkin’s Lymphoma presented with dizziness and syncope. He was found to be in CHB associated with hypotension requiring a transvenous pacemaker. Methylprednisolone and remdesivir were started with rapid resolution of the CHB. Further study is needed to determine the mechanism of CHB in COVID‐19. This case underscores the importance of including COVID‐19 in one’s differential diagnosis for acute CHB. The coronavirus disease 2019 (COVID-19) pandemic has had a profound global impact with over 120 million cases and 3 million fatalities worldwide. 1 Since the onset of this pandemic, cardiovascular complications have increased in prevalence. 3, 7 Myocardial involvement has been reported in 8%-28% of adults infected with SARS-CoV-2. 5 Cardiac arrhythmias are common in patients with COVID-19. 2, 6, 13 Supraventricular arrhythmias have been frequently reported, with atrial fibrillation being the most common. Ventricular arrhythmias have also been reported. 3 Severe bradyarrhythmias are relatively rare with only a few cases reported in the literature. 8 We report an unusual case of reversible complete heart block in a patient with acute SARS-CoV-2 infection and COVID-19 myocarditis. Figure 3A ). Our patient developed reversible complete heart block in the setting of acute COVID-19 myocarditis. Few cases of complete heart block in patients with COVID-19 have been recently reported in the literature. Complete heart block has been reported both in patients with and without any pre-existing conduction disease. 8, 9, 10 Cases of transient heat block in the setting of COVID-19 have been reported with subsequent resolution with clinical improvement. 10 However, persistent heart block requiring pacemaker implantation despite resolution of COVID-19 has also been reported. 8, 9, 11 The mechanism of arrhythmias and heart block in COVID-19 remains unclear. This patient exhibited rapid resolution of CHB and rapid clinical improvement with early administration of high dose steroids and anti-viral therapy with remdesivir. Acute myocardial injury and cardiomyopathy is associated with an increased risk of arrhythmia. Acute myocarditis continues to be an important cause of AV block in young patients. One purported mechanism of cardiac involvement is direct myocar- Further study is needed to elucidate the underlying mechanism of conduction disease and heart block in patients infected with SARS-CoV-2. The impact of pre-existing cardiac conduction disease and concomitant co-morbidities on the risk of developing heart block in COVID-19 needs further investigation. Complete heart block is a relatively rare complication of SARS-CoV-2 infection. Additional studies are needed to determine the short and long-term impact of SARS-CoV-2 infection on the cardiac conduction system, underlying mechanism of CHB, risk factors for development heart block in COVID-19, and prognostic implications. This case underscores the importance of including COVID-19 in one's differential diagnosis for patients presenting in CHB. As in this case, a multi-specialty team-based approach involving electrophysiologists, advanced heart failure specialists, interventional cardiologists, and infectious diseases specialists can help facilitate optimal management in challenging cases of COVID-19 complicated by heart block, myocardial injury, and myocardial dysfunction. World Health Organization (WHO) Coronavirus (COVID-19) Dashboard Potential effects of coronaviruses on the cardiovascular system: a review COVID-19 and cardiac arrhythmias: a global perspective on arrhythmia characteristics and management strategies COVID-19 and cardiovascular disease Complete heart block, severe ventricular dysfunction, and myocardial inflammation in a child with COVID-19 infection COVID-19 and cardiac arrhythmias Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China Bradyarrhythmias in patients with COVID-19: marker of poor prognosis? A case of complete heart block in a COVID-19 infected patient Heart block in patients with coronavirus disease 2019: a case series of 3 patients infected with SARS-CoV-2 Case report: high-grade atrioventricular block in suspected COVID-19 myocarditis Coronaviruses and the cardiovascular system: acute and long-term implications Cardiac arrhythmias in COVID-19 infection SARS-coronavirus modulation of myocardial ACE2 expression and inflammation in patients with SARS The emerging spectrum of cardiopulmonary pathology of the coronavirus disease 2019 (COVID-19): Report of 3 autopsies from Houston, Texas, and review of autopsy findings from other United States cities No conflict of interest to be reported. Data sharing is not applicable to this article as no datasets were generated or analyzed for this case report. John Kassotis MD, FHRS https://orcid.org/0000-0002-2588-9331