Complete atrioventricular block due to multisystem inflammatory syndrome in children: a case report

Cardiac manifestations in multisystem inflammatory syndrome in children (MIS-C) may involve the conduction system. The incidence and publication is still very limited. We report the case of a 2-year-old girl who presented with complete atrioventricular (AV) block with a current infection of SARS-CoV-2 and fulfilled the criteria of MIS-C. After observation for 2 weeks of the SARS-CoV-2 convalescence phase and temporary pacemaker insertion, the complete AV block was not resolved. The intrinsic junctional escape beat was only 40 beats/minute. We decided to implant a dual-chamber epicardial permanent pacemaker to maintain synchrony between atrium and ventricle and furthermore provide hemodynamic stability. We observed persistent complete AV block 9 months after SARS-CoV-2 infection in long-term follow up of this patient. Complete AV block in MIS-C could persist months after its onset. Our case could give additional knowledge regarding the natural history of cardiac involvement after SARS-CoV-2 infection.