Heart Block in the Patients with COVID-19

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.