Setting and patient details/history:
In December 2019, SARS-CoV-2, a new strain of coronavirus was identified in Wuhan, China. By March of 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic. According to the WHO as of February 7, 2022, 410,565,868 cumulative cases of COVID-19 infection have been confirmed with 5,810,88 deaths worldwide. As of February 14, 2022, 77,707,349 had confirmed COVID-19 infection in the United States with 919,255 deaths.
While the symptoms of COVID-19 can vary the most common symptoms, including fever, dry cough, and occasionally diarrhea, usually develop within 2 to 14 days of exposure. [1] An early study on clinical characteristics of COVID-19 patients from Wuhan, China reported that the primary infection develops in the respiratory tract with resulting complications being predominantly acute respiratory distress and secondly arrhythmias, experienced in 44% of patients requiring intensive care. [2] While respiratory complications are the main clinical manifestation of COVID-19, cardiovascular issues including thromboembolic events, myocarditis, and pericarditis are not uncommon. Cardiac injury has been reported in 19.7% of patients during hospitalization. [3,4]
Cardiac arrhythmias are common in patients with COVID-19 infection. It appears to be related to direct injury due to COVID-19 infection and the multi-organ injury leading to arrhythmias. Adverse reactions to multiple drugs used in critically ill patients with COVID-19 infection also play a role in the occurrence of cardiac arrhythmias.  A recent large study of  700 patients with COVID-19 receiving intensive care revealed 9 cardiac arrests, 9 bradyarrhythmias, 25 incident atrial fibrillation, and 10 non-sustained ventricular arrhythmias [5]. The occurrence of cardiac arrests was associated with an increase in mortality.
The occurrence of bradycardia in patients with COVID-19 infection is not uncommon. A  retrospective case series of four patients with significant bradycardia revealed mostly sinus bradycardia occurring after 9 to  15 days post-admission. [6] All four patients were treated sometime during their stay with propofol and during bradycardia and 3 patients were receiving corticosteroid therapy. The etiology of transient sinus bradycardia is multifactorial needing increasing awareness. There have been case reports of patients developing cardiac conduction abnormalities in the setting of COVID-19 but there have been no reports of patients experiencing permanent AV block and only a few reports of young patients developing transient or lesser degrees of AV block. [1-3,7-11] In this case, we present a young patient hospitalized with COVID-19 who was found to have symptomatic bradycardia secondary to permanent third-degree atrioventricular (AV) heart block. The case is presented without identifier and based on IRB, consent is waved.