Mid-term follow-up of COVID-19 patients with permanent pacemaker implantation due to bradyarrhythmia at the acute phase of infection

Abstract

BACKGROUND: Arrhythmia is one of the important cardiac manifestations of SARSCoV-2 disease with possible mechanisms such as direct damage to the myocardium, hypoxia, myocardial damage, cytokine storm, and electrolyte imbalances. Bradyarrhythmia is a manifestation of conduction system involvement, which is associated with an unfavorable prognosis and sometimes requires treatments such as implanting a pacemaker. Whether bradycardia in the acute phase of the COVID pandemic is a transient complication of the virus or whether it will be permanent can affect the treatment approach. Is the effect of SARS-CoV-2 on the conduction system of the heart temporary or permanent, and in the one-year follow-up, how many patients will need a pacemaker? METHODS: The study population was among patients with symptomatic bradyarrhythmias who were referred to Chamran Heart Center, Isfahan, Iran, from the outbreak of SARS-CoV-2 (February 2020) until February 2022 and were diagnosed with COVID-19 based on the polymerase chain reaction (PCR) test. They underwent permanent pacemaker implantation and were monitored for 1 month and 12 months after device implantation. RESULTS: The most common comorbid disease was hypertension. Systolic blood pressure and respiratory rate in hospitalized patients decreased significantly during discharge. Also, oxygen saturation and heart rate increased significantly during discharge (P < 0.001). In this study, high-degree atrioventricular block remained permanent in most patients and was not transient. CONCLUSION: Based on the experiences gained from this study, the implantation of a permanent pacemaker for the treatment of bradyarrhythmia should be done based on the existing guidelines, regardless of the status of COVID-19.