Original Article

Clinical Characteristics and Outcomes of Patients Hospitalized for COVID-19 Pneumonia Who Developed Bradycardia

Authors: Fernando Stancampiano, MD, Mohamed Omer, MD, Dana Harris, MD, Jose Valery, MD, Michael Heckman, MS, Launia White, MS, Claudia Libertin, MD

Abstract

Objective: To assess the clinical characteristics and clinical outcomes of bradycardic patients with coronavirus disease 2019 (COVID-19) pneumonia.

Methods: The electronic medical records of 221 consecutive patients hospitalized for COVID-19 pneumonia between June and September 2020 were retrospectively reviewed. Patient characteristics, electrocardiographic data, and clinical and laboratory information were retrospectively collected. Patients not treated with drugs that blunt chronotropic response (nodal) were analyzed separately.

Results: Only patients whose heart rate was <60 beats per minute (bpm) (136/221, 61.5%) were included. Serial electrocardiography revealed that most patients (130/137, 97.7%) remained in sinus rhythm. The heart rate was between 50 and 59 bpm in 75% of the patients, while 18.4% were in the 40 to 49 bpm range, and 6.6% were <40 bpm. Medians for development of bradycardia after swab polymerase chain reaction positivity and duration of bradycardia were 41 hours and 5 days, respectively. Bradycardia resolved in 81 patients (59.6%). There were no statistically significant differences in outcomes according to degree of bradycardia (<50 vs 50–59, all P ≥ 0.073). No significant differences were noted for the overall cohort when comparing COVID-19 treatments according to resolution of bradycardia; however, when considering only the patients who were not receiving a nodal agent or antiarrhythmic, treatment with lenzilumab was more common in patients with resolution of bradycardia than patients without resolution of bradycardia (12.2% vs 0.0%, P = 0.030).

Conclusions: Sinus bradycardia occurs frequently in patients with severe COVID-19, but the degree of bradycardia does not correlate with clinical outcomes. Lenzilumab may be associated with the resolution of bradycardia.
Posted in: Cardiovascular Disease36 Infectious Disease136

Full Article

Having trouble viewing the article content below? Click here to open it directly.

Images

Download Image

Download Image

Download Image

Download Image

References

1. Topol EJ. COVID-19 can affect the heart. Science 2020;370:408–409.
 
2. Stefanini GG, Montorfano M, Trabattoni D, et al. ST-elevation myocardial infarction in patients With COVID-19: clinical and angiographic outcomes. Circulation 2020;141:2113–2116.
 
3. Rey JR, Caro-Codón J, Rosillo SO, et al. Heart failure in COVID-19 patients: prevalence, incidence and prognostic implications. Eur J Heart Fail 2020;22:2205–2215.
 
4. Shchedrygina A, Nagel E, Puntmann VO, et al. COVID-19 myocarditis and prospective heart failure burden. Expert Rev Cardiovasc Ther 2021;19:5–14.
 
5. Abrams MP, Coromilas EJ, Wan EY, et al. Malignant ventricular arrhythmias in patients with severe acute respiratory distress syndrome due to COVID-19 without significant structural heart disease. HeartRhythm Case Rep 2020;6:858–862.
 
6. Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020;5:1265–1273. .
 
7. Amaratunga EA, Corwin DS, Moran L, et al. Bradycardia in patients With COVID-19: a calm before the Sstorm? Cureus 2020;12:e8599.
 
8. Hu L, Gong L, Jiang Z, et al. Clinical analysis of sinus bradycardia in patients with severe COVID-19 pneumonia. Crit Care 2020;24:257.
 
9. Ostergaard L, Huniche B, Andersen PL. Relative bradycardia in infectious diseases. J Infect 1996;33:185–191.
 
10. Capoferri G, Osthoff M, Egli A, et al. Relative bradycardia in patients with COVID-19. Clin Microbiol Infect 2021;27:295–296.
 
11. Zhao Q, Meng M, Kumar R, et al. Lymphopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: a systemic review and meta-analysis. Int J Infect Dis 2020;96:131–135.
 
12. Gómez-Mesa JE, Galindo-Coral S, Montes MC, et al. Thrombosis and coagulopathy in COVID-19. Curr Probl Cardiol 2020;46:100742.
 
13. Piazza G, Campia U, Hurwitz S, et al. Registry of arterial and venous thromboembolic complications in patients With COVID-19. J Am Coll Cardiol 2020;76:2060–2072.
 
14. Szekely Y, Lichter Y, Taieb P, et al. Spectrum of cardiac manifestations in COVID-19: a systematic echocardiographic study. Circulation 2020;142:342–353.
 
15. Argulian E, Sud K, Vogel B, et al. Right ventricular dilation in hospitalized patients with COVID-19 infection. JACC Cardiovasc Imaging 2020;13:2459–2461.
 
16. Pagnesi M, Baldetti L, Beneduce A, et al. Pulmonary hypertension and right ventricular involvement in hospitalised patients with COVID-19. Heart 2020;106:1324–1331.
 
17. Andersen KG, Rambaut A, Lipkin WI, et al. The proximal origin of SARSCoV-2. Nat Med 2020;26:450–452.
 
18. Chen L, Li X, Chen M, et al. The ACE2 expression in human heart indicates new potential mechanism of heart injury among patients infected with SARS-CoV-2. Cardiovasc Res 2020;116:1097–1100.
 
19. Lindner D, Fitzek A, Brauninger H, et al. Association of cardiac infection with SARS-CoV-2 in confirmed COVID-19 autopsy cases. JAMA Cardiol 2020;5:1281–1285.
 
20. Scappaticcio L, Pitoia F, Esposito K, et al. Impact of COVID-19 on the thyroid gland: an update. Rev Endocr Metab Disord 2020;DOI:10.1007/ s11154-020-09615-z.
 
21. Beyls C, Martin N, Hermida A, et al. Lopinavir-ritonavir treatment for COVID-19 infection in intensive care unit: risk of bradycardia. Circ Arrhythm Electrophysiol 2020;13:e008798.
 
22. Unudurthi SD, Luthra P, Bose RJC, et al. Cardiac inflammation in COVID-19: lessons from heart failure. Life Sci 2020;260:118482.
 
23. Chinitz JS, Goyal R, Harding M, et al. Bradyarrhythmias in patients with COVID-19: marker of poor prognosis? Pacing Clin Electrophysiol 2020;43:1199–1204.
 
24. Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the treatment of Covid-19 - final report. N Engl J Med 2020;383:1813–1826.
 
25. Simonovich VA, Burgos Pratx LD, Scibona P, et al. A randomized trial of convalescent plasma in Covid-19 severe pneumonia. N Engl J Med 2021;384:619–620.
 
26. Salazar E, Christensen PA, Graviss EA, et al. Significantly decreased mortality in a large cohort of coronavirus disease 2019 (COVID-19) patients transfused early with convalescent plasma containing high-titer anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Spike protein IgG. Am J Pathol 2021;191:90–107.
 
27. Temesgen Z, Assi M, Shweta FNU, et al. GM-CSF neutralization with lenzilumab in severe COVID-19 pneumonia: a case-cohort study. Mayo Clin Proc 2020;95:2382–2394.
 
28. Centers for Disease Control and Prevention. Risk for COVID-19 infection, hospitalization, and death by race/ethnicity. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html. Published 2020. Accessed January 28, 2021.