New Onset PVC Bigemini Post Covid-19 Infection :Another Covid-Cardiac Related

Problem
B. Jeremiah, A.C. Lubis, H. Hasan,
Departemen of Cardiology and Vascular Medicine
School of Medicine, Universitas Sumatera Utara, Medan, Sumatera Utara

Background:
Covid-19 is an infectious disease caused by a newly discovered coronavirus that can caused acute
severe respiratory syndrome and other complication. Many cardiac complication already ocured
such as carditis and acute heart failure. PVC Bigemini is a new complication that we found in our
post covid-19 patient.
Case Summary:
A 31-years-old female patient was admitted to the outpatient clinic with chief complaint of
palpitation with chest discomfort in the past 1 month. Despite the medication she had from
cardiologist from other hospital before, the symptoms still appear. She had a history of covid-19
infection 3 months ago with prolong covid infection for 2 months. ECG showed Sinus rhythym
and bigemini PVC with PVC LBBB morphology left inferior axis and transition zone in V4 . We
do the laboratory examination and echocardiography then the patient admitted to ward and
planned to do Electrophysiology study and ablation in the next day. From the EP study we found
2 type of PVC, both of the PVC have LBBB morphology with left inferior axis and transitional
zone in V4. The first PVC had 42ms earliest activation time and the second PVC had 48ms
earliest activation. We decide to do ablation with non irrigathing catheter on the first PVC but the
PVC still remain.Then we decide to change the ablation catheter with irrigathing catheter and do
the ablation again. After the ablation the PVC already vansihed and the ablation was succesful.
We do the ecg evaluation in the next morning and the PVC was not found and.
Discussion:
PVC bigemini post covid-19 infection is a rare case of complication in covid-19 patient. Despite
the covid-19 condition, PVC bigemini can cause several complain from palpitation, chest
discomfort, shortness of breath and other complains. Ablation is one of the best way to treat PVC
bigemini patient with symptoms and in the patient the ablation was succeful and the symptoms
was gone.

Keyword: PVC bigemini,Covid-19,Ablation

1. EKG Poli

2. CXR
3. Baseline EKG saat EP Study

4. Mapping PVC 1
5. Mapping PVC 2

6. Pace Map pada EP Study

7. EKG Post Ablasi

8. EKG post ablasi 1 minggu kemudian saat kontrol di poli