Document Type : Case Report


1 Department of Cardiology, Urmia University of Medical Sciences, Urmia, Iran

2 Cardiovascular Research Center, Shahid-Rahimi Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran


Covid19 is still one of the major public health problems of all countries nowadays. The most common cardiac manifestations reported till now are acute coronary syndrome, myocarditis, and arrhythmia. The prevalence
of COVID-19 induced arrhythmias is different in recent reports and varies from benign sinus tachycardia to
more ominous cases of severe bradycardia or even malignant ventricular arrhythmias. Here in, we describe
a case of complete heart block in severe covid-19 pneumonia and review all recent relevant case reports
published to date in order to understand the probable mechanisms and contributing factors of this rare
complication of the disease.


  1. Hajizadeh R, Behnemoon M. Is the new coronavirus disease (COVID-19) pandemic halted by malaria epidemics? Arch Bone Joint Surg 2020; 8(Suppl 1): 319.
  2. Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): a review. Jama 2020; 324(8): 782-93.
  3. Adhikari SP, Meng S, Wu YJ, Mao YP, Ye RX, Wang QZ, Sun C, Sylvia S, Rozelle S, Raat H, Zhou H. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review. Infect Dis Poverty 2020; 9(1): 1-2.
  4. Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, Bikdeli B, Ahluwalia N, Ausiello JC, Wan EY, Freedberg DE. Extrapulmonary manifestations of COVID-19. Nat Med 2020; 26(7): 1017-32.
  5. Bansal M. Cardiovascular disease and COVID-19. Diabetes Metabo Syndr Clin Res Rev 2020; 14(3): 247-50.
  6. Kochi AN, Tagliari AP, Forleo GB, Fassini GM, Tondo C. Cardiac and arrhythmic complications in patients with COVID‐ J Cardiovas Electrophysiol 2020; 31(5): 1003-8.
  7. Bhatla A, Mayer MM, Adusumalli S, Hyman MC, Oh E, Tierney A, Moss J, Chahal AA, Anesi G, Denduluri S, Domenico CM. COVID-19 and cardiac arrhythmias. Heart Rhythm 2020; 17(9): 1439-44.
  8. Long B, Brady WJ, Koyfman A, Gottlieb M. Cardiovascular complications in COVID-19. Am J Emergency Med 2020; 38(7): 1504-7.
  9. Babapoor-Farrokhran S, Rasekhi RT, Gill D, Babapoor S, Amanullah A. Arrhythmia in COVID-19. SN Comprehen Clin Med 2020; 2(9): 1430-5.
  10. Mohamed A. Complete heart block secondary to COVID-19. Cureus 2021; 13(5).
  11. El-Assaad I, Hood-Pishchany MI, Kheir J, Mistry K, Dixit A, Halyabar O, Mah DY, Meyer-Macaulay C, Cheng H. Complete heart block, severe ventricular dysfunction, and myocardial inflammation in a child with COVID-19 infection. Case Rep 2020; 2(9): 1351-5.
  12. Nikoo MH, Mozaffari R, Hatamnejad MR, Bazrafshan M, Kasaei M, Bazrafshan H. Systolic dysfunction and complete heart block as complications of fulminant myocarditis in a recovered COVID-19 patient. J Cardiol Cases 2021; 24(4): 177-81.
  13. Al-Assaf O, Mirza M, Musa A. Atypical presentation of COVID-19 as subclinical myocarditis with persistent high-degree atrioventricular block treated with pacemaker implant. HeartRhythm Case Rep 2020; 6(11): 884-7.
  14. Haddadin FI, Mahdawi TE, Hattar L, Beydoun H, Fram F, Homoud M. A case of complete heart block in a COVID-19 infected patient. J Cardiol Cases 2021; 23(1): 27-30.
  15. Mahdawi TE, Wang H, Haddadin FI, Al-Qaysi D, Wylie JV. Heart block in patients with coronavirus disease 2019: a case series of 3 patients infected with SARS-CoV-2. HeartRhythm Case Rep 2020; 6(9): 652-6.
  16. Hosseini Z, Ghodsi S, Hejazi SF. Persistent complete heart block in a patient with COVID-19 infection: a case report. SN Comprehen Clin Med. 2021; 3(1): 259-62.
  17. Villasmil RJ, Lorenzo CJ, Abdelal QK, Conte JI, Lattanzio N. Complete Heart Block in a Patient with COVID-19. Int Arch Cardiovasc Dis 2021; 5: 039.
  18. Maknojia A, Gilani A, Ghatak A. Complete Heart Block: A Rare Presentation of COVID-19. Cath Lab Digest 2021; 29(5).
  19. Azarkish M, Laleh Far V, Eslami M, Mollazadeh R. Transient complete heart block in a patient with critical COVID-19. European Heart J 2020; 41(22): 2131-.
  20. Pavri BB, Kloo J, Farzad D, Riley JM. Behavior of the PR interval with increasing heart rate in patients with COVID-19. Heart rhythm 2020; 17(9): 1434-8.
  21. De La Flor Merino JC, Mola Reyes L, Linares Gravalos T, Roel Conde A, Rodeles del Pozo M. An unusual case of severe acute hyponatremia in patient with COVID-19 infection. Nefrología 2020; 40(3): 356-8. (English Edition)
  22. Steere AC, Batsford WP, Weinberg M, Alexander J, Berger HJ, Wolfson S, Malawista SE. Lyme carditis: cardiac abnormalities of Lyme disease. Ann Int Med 1980; 93(1_Part_1): 8-16.