Key result
Permanent AV block in COVID-19 is linked to ~4-fold higher mortality than transient block.
Why the study?
Bradyarrhythmia in SARS-CoV-2 infection poses the dilemma of urgent pacing, but data on patient characteristics and clinical outcomes in this population are lacking.
What are the clinical characteristics and outcomes of bradyarrhythmia in hospitalized patients with SARS-CoV-2 infection?
Systematic Review (n=151)
What are the clinical characteristics and outcomes of bradyarrhythmia in hospitalized patients with SARS-CoV-2 infection?
Absolute Event Rate: 23.1% vs 5.6%
p-value: p=0.048
COVID-19-associated bradyarrhythmias, including sinus node dysfunction and AV block, occur even in young patients and carry a significant risk of mechanical ventilation and mortality, particularly with permanent AV block.
Bradyarrhythmia in COVID-19 signals need for vigilant monitoring; leaves open causal roles of antivirals and optimal pacing strategies.
Background Among arrhythmias observed in SARS‐CoV‐2 infection, bradyarrhythmia poses the dilemma of urgent pacing. In this population, data on patients' characteristics and clinical outcomes are lacking. Methods A systematic literature search was conducted for bradyarrhythmia associated with COVID‐19 from inception to December 2024 following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses Extension for Scoping Reviews guidelines; quality assessment was performed using the Joanna Briggs Institute critical appraisal tool. From each report, the type of bradyarrhythmia, relevant clinical variables, and outcomes were extracted. Comparison between groups with different bradyarrhythmias was performed for the variables available in all cases. Cluster analyses were performed using both the k‐means and hierarchical methods. Results Overall, 103 case series/case reports were identified reporting data on 151 patients: 76 with sinus node dysfunction and 75 with atrioventricular block (AVB). Median age was 54.5 years; 10.6% were pediatric patients. Despite few comorbidities, 24.5% required mechanical ventilation and 11.3% died. Sinus node dysfunction was more frequently associated with antiviral therapy, while patients with permanent AVB were significantly older (58 versus 48.5 years; P =0.011) and showed a significant trend toward a higher mortality rate (23.1% versus 5.6%; P =0.048) than those with transient AVB. Cluster analyses showed a higher inflammatory profile in younger patients associated with left ventricular dysfunction and AVB. Conclusions COVID‐19 can be associated with sinus node dysfunction or AVB even in a young patient population exhibiting a high inflammatory profile. The need for mechanical ventilation and the mortality rate was not negligible. Sinus node dysfunction was associated with the use of antiviral therapy, and permanent AVB was associated with a higher mortality rate.
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Blasi et al. (2026) conducted a systematic review in SARS-CoV-2 infection with bradyarrhythmia (n=151). Permanent atrioventricular block vs. Transient atrioventricular block was evaluated on Mortality rate (p=0.048). In patients with COVID-19, permanent atrioventricular block was associated with a higher mortality rate compared to transient atrioventricular block (23.1% vs 5.6%; P=0.048).
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