Dr. Roach: Can COVID be the cause of heart block?

Keith Roach
To Your Health

Dear Dr. Roach: Is COVID-19 infection a cause of heart block? I recently had a complete heart block, tested positive in the ER for COVID-19 (symptomless and post-vaccine), and was fitted with a permanent pacemaker. I’m 63, female, in good health except for a luckily nonsevere, 10-year diagnosis of Sjogren’s syndrome.

My cardiologist doesn’t think the heart block is due to COVID-19, but I’ve seen articles in Medline reporting cases of heart block during COVID-19 infection. Is it too early in the disease’s research to know for sure?

Dr. Keith Roach

— B.J.S.

Dear B.J.S.: Heart block is a condition where the electrical impulse from the top chambers of the heart to the bottom are completely blocked. I found case reports and a case series of people developing heart block while in the hospital with COVID-19 infection. In the case series, all three patients were severely ill — rhythm problems can happen in people with critical illness from any cause — and all cases of heart block recovered without need for pacemaker. In a larger series of 700 COVID-19 patients monitored for rhythm problems, none developed heart block.

While it is plausible the COVID-19 infection may have caused your heart block, this complication seems to be uncommon. It may also be that it just happened to occur (or at least was noticed) at the same time you had an asymptomatic case of COVID-19. There are case reports of heart block developing in people with Sjogren’s syndrome, an autoimmune disease that particularly affects the cells that produce saliva and tears. It’s possible that it was the Sjogren’s, not COVID-19, that caused the permanent heart block.

Dear Dr. Roach: I am one of a group of four cousins who socialize together. Three of us are vaccinated and boosted, and one is vaccinated but refuses to get the booster.

I have common variable immunodeficiency. Both my IgA and IgG are very low. I get IGG infusions, but I still get many infections. I have been on eight courses of antibiotics and several courses of prednisone from May to December 2021. I have told the unboosted cousin I can’t socialize with him any longer due to the risk of COVID-19. He says I’m overreacting, that he’s gotten two vaccines and is no more of a risk than anyone else. His last shot was March 21, 2021. What do you think?

— D.S.

Dear D.S.: Common variable immunodeficiency often has minimal symptoms, and many people have it and do not realize it. They may get somewhat more frequent respiratory infections than others. When the immunoglobulin levels (IgA and IgG are different types of immunoglobulins, also called antibodies) are low, the person with common variable immunodeficiency is at higher risk. Immunoglobulin IgG infusion (also called gamma globulin) helps to reduce risk, but it does not completely replace the immune system deficiency. In those cases, there is also the real risk that vaccines are going to be less effective or ineffective.

Because of your primary immunodeficiency, I agree with you that minimizing your exposure is critical. “Potentially life-saving” is not too strong a phrase to use, and your cousin should at the very least respect your medical needs. It is very clear that a third dose significantly reduces risk of developing COVID-19, although with the omicron variant, even people with three doses are still getting disease, which is why managing your exposure is so critical.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.