Impact of COVID-19 on remote cardiovascular endpoints in patients with sick sinus syndrome and an implanted pacemaker

SARS-CoV2, responsible for the COVID-19 pandemic, is still relevant for the medical system throughout the world. In addition to the effect on the respiratory system, cardiac manifestations of COVID-19 are also known in the acute and post-COVID-19 period, including known coronary heart disease, proarrhythmogenic effects including impact on sick sinus syndrome (SSS). Cardiovascular diseases including myocarditis, heart failure, tachyarrhythmias and myocardial infarction, where arrhythmias are widespread were detected among hospitalized patients with COVID-19. Objective: To investigate the impact of COVID-19 incidence on long-term cardiovascular endpoints in patients with SSS with implanted pacemaker. Methods. In a retrospective, non-randomized, uncontrolled study, 447 patients with SSS were examined, of which 205 patients experienced and 242 - did not have COVID-19. The follow-up period was 30 months and the endpoints were cardiovascular death, myocardial infarction, stroke and cardiovascular hospitalization. Adverse cardiovascular events were monitored using the “Promed” electronic medical record system, as well as during follow-up examinations at the consultative and diagnostic clinic. Results. Comparison of the incidence of adverse cardiovascular endpoints in the COVID-19 and control groups showed no differences in all endpoints according to the Chi-square test (p>0.1), with the exception of frequency of myocardial infarction in the “COVID-19” (p=0.040). The close relationship between tachy-bradicardia, microvascular dysfunction and coronary artery disease, and at the same time the impossibility of modulating the heart rhythm in the presence of vegetative dysfunction and an established pacemaker assumed that autonomic dysfunction in post-COVID patients caused myocardial ischemia and, as a result, an increase of myocardial infarction rate. Conclusion. During long-term follow-up, COVID-19 in patients with SSS increased the risk of myocardial infarction. Keywords: sinus node weakness syndrome, COVID-19, pacemaker, coronary artery disease, cardiovascular endpoints.