Heart Block in the Patients with COVID-19

  1. Md Ripon Ahammed
  2. Medha Sharath
  3. Mehul Sinha
  4. Cristina Sestacovschi
  5. Varadha Retnakumar
  6. Naisargee Solanki

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Abstract

Background

Since the emergence of the SARS COV-19 pandemic, multiple extrapulmonary manifestations of the virus have been reported from around the world. Cardiovascular complications including arrhythmias in patients with COVID-19 have been described in multiple studies. Our aim was to review various case reports detailing the new onset of heart block in COVID-19 patients and to summarise the clinical course of these patients.

Methods

We systematically reviewed all reports published and indexed in PubMed, Scopus, and Embase between March 2020 to May 2021, analyzing the relation between the demographics of the patients, pre-existing comorbidities, and the progression of heart block in patients infected with COVID-19.

Results

We identified and included in this study 30 relevant articles describing 49 COVID-19 patients with heart block. Among them, 69.3% (n=34) of patients suffered from at least one comorbidity. 36.73% (n=18) of the patients showed spontaneous resolution of the heart block. Conversely, 63.26% (n=31) of the patients had persistent heart block, out of which 16.33% (n=8) and 42.86% (n=21) were implanted with a temporary and permanent pacemaker respectively. The reported mortality rate was 22.45% (n=11) during hospitalization. We noted that 45.45% (n=5) of the patients who died had complete heart block. 24.49% (n=12) of the patients in the studies we reviewed were suspected of having myocarditis. However, none were confirmed with MRI or cardiac biopsy.

Conclusions

Additional research is necessary to unearth the mechanism of development of heart block in COVID-19 patients as well as its implications on the clinical course and prognosis. Physicians must be aware of the importance of monitoring patients hospitalized for COVID-19 for arrhythmias including heart blocks, especially in the presence of comorbidities. Early detection can improve the prognosis of the patient.

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  1. ScreenIT

    SciScore for 10.1101/2022.01.05.22268779: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The systematic search was carried out in May 2021 utilizing PubMed (Medline), Scopus, and Embase.
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    Embase
    suggested: (EMBASE, RRID:SCR_001650)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: One of the limitations of our systematic review was the restricted number of studies and size of the sample population. We have only included studies published until May 2021. Future reports of heart block in COVID-19 patients might reveal new relations between the severity of the infection and the prognosis of patients who develop heart block. The resolution of ECGs changes after discontinuation of HCQ in a case suggests a causal relationship between hydroxychloroquine and ECG abnormalities. Thus the role of certain medications, like hydroxychloroquine, on the development of arrhythmias in the presence of COVID-19 infection must also be further investigated 26. Also, the presence of COVID-19 induced myocarditis was not confirmed via biopsy or MRI in any of the patients who developed heart block in our included studies. Conclusion: The exact pathogenesis of heart block in COVID-19 patients must be further explored. More research is required to determine whether myocarditis due to COVID-19 is associated with the development of heart blocks. It is also needed to be studied further whether heart block is an independent risk factor for a worse prognosis in COVID-19 cases. Patients hospitalized for COVID-19 must be continuously monitored for arrhythmias including heart blocks, especially in the presence of comorbidities. Physicians must be made aware of these cardiac manifestations of the infection, as early detection can shorten the hospital stay and improve the prog...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  2. Version published to 10.1101/2022.01.05.22268779v1 on medRxiv