Complete Heart Block Secondary to COVID-19

In our everyday practice with COVID-19 patients, we noticed that they are not tachycardic even when critically ill and shocked on pressors they are bradycardic. Most of them are in sinus rhythm. However, some of them go into advanced degree heart block and had cardiac arrest related to complete heart block. A 72-year-old female with a history of hypertension and diabetes admitted with COVID-19 bronchopneumonia. The hospital course has been complicated by respiratory failure requiring mechanical ventilation and septic shock requiring norepinephrine. It was noted that she is bradycardic in the 50s in sinus rhythm, her heart rate dipped down to 30 for about six seconds, and her telemetry strip showed evidence of complete heart block, and then she was back in sinus rhythm. The decision was made to follow-up, given that it was for a short time and did not recur. The next day she had cardiac arrest related to a complete heart block, and a temporary trans-venous pacemaker was placed, Later when her condition improved, her heart rate started recovering gradually. At first, she was in junctional tachycardia, and one week later, she was back in sinus rhythm. The temporary pacemaker was removed, and she was discharged on a ZIO monitor for two weeks with no further evidence of bradycardia. Bradycardia in COVID-19 patients is frequently reported. It is not always benign and should be managed promptly when there is evidence of advanced heart block.