Prognostic Clinical Characteristics Associated with High Mortality in COVID-19 Patients with Bradycardia: A Case Series Study

Background: Coronavirus SARS-CoV-2 infection is associated with cardiovascular morbidity and mortality, even in individuals without pre-existing cardiovascular disease. Various types of arrhythmias have been reported in COVID-19 patients, including bradycardia, although its relationship to mortality remains unclear. Objectives: This study aimed to present a case series of patients with bradyarrhythmia and examine factors associated with mortality. Methods: In this case series, we reported 50 patients with confirmed COVID-19 who developed significant sustained bradycardia during hospitalization and were transferred to the critical care unit. We analyzed their clinical condition, associated features during hospitalization, and both hospital and one-month mortality rates. Statistical analyses were performed using SPSS software, including correlation analyses and P-value calculations. Results: The mean age of the patients was 63.7 ± 19.3 years, and the mean heart rate was 29.12 ± 6.38 beats per minute. There was no significant relationship between bradycardia and fever or the severity of pulmonary involvement. However, a significant difference was observed in several clinical parameters, including troponin, ferritin, lactate dehydrogenase (LDH), lymphopenia, oxygen saturation at the time of discharge, and C-reactive protein (CRP) between patients who died and those who survived. Eight patients in our study were diagnosed with acute coronary syndrome (ACS), but none had ST-segment elevation myocardial infarction (STEMI). Four patients developed complete heart block, three of whom received a temporary pacemaker. Conclusions: The mortality rate was higher in this group of patients compared to those without bradycardia. Bradycardia in these patients appeared to predict death with higher sensitivity than specificity, suggesting it could serve as a prognostic marker for an unfavorable disease course, particularly in intensive care unit (ICU) patients.