Department of Cardiology, Bispebjerg and Frederiksberg Hospital, 2400, Copenhagen, Denmark.
Department of Cardiology, Zealand University Hospital, 4000, Roskilde, Denmark.
BMC Cardiovasc Disord. 2023 Jan 25;23(1):46. doi: 10.1186/s12872-023-03080-7.
SARS-CoV-2 may trigger both vasculitis and arrhythmias as part of a multisystem inflammatory syndrome described in children as well as in adults following COVID-19 infection with only minor respiratory symptoms. The syndrome denotes a severe dysfunction of one or more extra-pulmonary organ systems, with symptom onset approximately 2-5 weeks after the COVID-19 infection. In the present case, a seemingly intractable ventricular tachycardia preceded by SARS-CoV2 infection was only managed following the diagnosis and management of aortitis.
A 69-year-old woman was hospitalized due to syncope, following a mild COVID-19 infection. She presented with paroxysmal atrial fibrillation and intermittent ventricular tachycardia interpreted as a septum-triggered bundle branch reentry ventricular tachycardia, unaffected by amiodaron, lidocaine and adenosine. A CT-scan revealed inflammation of the aortic arch, extending into the aortic root. In the following days, the tachycardia progressed to ventricular storm with intermittent third-degree AV block. A temporary pacemaker was implanted, and radiofrequency ablation was performed to both sides of the ventricular septum after which the ventricular tachycardia was non-inducible. Following supplemental prednisolone treatment, cardiac symptoms and arrythmia subsided, but recurred after tapering. Long-term prednisolone treatment was therefore initiated with no relapse in the following 14 months.
We present a rare case of aortitis complicated with life-threatening ventricular tachycardia presided by Covid-19 infection without major respiratory symptoms. Given a known normal AV conduction prior to the COVID-19 infection, it seems likely that the ensuing aortitis in turn affected the septal myocardium, enabling the reentry tachycardia. Generally, bundle branch reentry tachycardia is best treated with radiofrequency ablation, but if it is due to aortitis with myocardial affection, long-term anti-inflammatory treatment is mandatory to prevent relapse and assure arrhythmia control. Our case highlights importance to recognize the existence of the multisystem inflammatory syndrome in adults (MIS-A) following COVID-19 infection in patients with alarming cardiovascular symptoms. The case shows that the early use of an CT-scan was crucial for both proper diagnosis and treatment option.
SARS-CoV-2 可能会引发血管炎和心律失常，这是一种多系统炎症综合征的一部分，在儿童以及 COVID-19 感染后仅有轻微呼吸道症状的成年人中均有描述。该综合征表示一个或多个肺外器官系统严重功能障碍，症状发作大约在 COVID-19 感染后 2-5 周。在本病例中，一种看似难治性的室性心动过速在 SARS-CoV2 感染之前发生，仅在诊断和治疗主动脉炎后得到控制。
一名 69 岁女性因轻度 COVID-19 感染后晕厥住院。她出现阵发性心房颤动和间歇性室性心动过速，被解释为间隔触发的束支折返性室性心动过速，不受胺碘酮、利多卡因和腺苷影响。CT 扫描显示主动脉弓炎症，延伸至主动脉根部。在接下来的几天里，心动过速进展为伴有间歇性三度房室传导阻滞的室性心动过速风暴。植入临时起搏器，并对室间隔两侧进行射频消融，此后室性心动过速无法诱发。在补充泼尼松龙治疗后，心脏症状和心律失常得到缓解，但在减量后再次复发。因此，启动了长期泼尼松龙治疗，在接下来的 14 个月内没有复发。
我们报告了一例罕见的 COVID-19 感染无主要呼吸道症状但并发危及生命的室性心动过速的主动脉炎病例。鉴于在 COVID-19 感染之前已知正常的房室传导，似乎很可能随后的主动脉炎反过来影响了间隔心肌，从而使折返性心动过速得以发生。一般来说，束支折返性心动过速最好通过射频消融治疗，但如果是由于主动脉炎合并心肌受累，则需要长期抗炎治疗以预防复发和确保心律失常控制。我们的病例强调了在有警报性心血管症状的 COVID-19 感染患者中识别成人多系统炎症综合征（MIS-A）的重要性。该病例表明，早期使用 CT 扫描对正确诊断和治疗选择至关重要。
