Permanent Pacemaker Placement Secondary to Remdesivir Induced Bradycardia: A Case Report

Remdesivir is approved by the FDA for the treatment of hospitalized coronavirus disease 2019 (COVID-19) patients. It is known to be associated with transient bradycardia that resolves after discontinuation of the drug. We present a case of a 71-year-old male with a history of congestive heart failure, hypertension, and atrial flutter (rate controlled with carvedilol) presented for evaluation of worsening dyspnea, dry cough, and fatigue. His COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) was positive and his chest x-ray showed right mid-lung opacity. Oxygen saturation was 88% on room air. He was started on dexamethasone and remdesivir. Bradycardia was noted on telemetry monitoring 48 hours after starting remdesivir. Carvedilol was discontinued, but the bradycardia persisted. Heart rate reached a nadir of 38 beats per minute (bpm) three days after completion of remdesivir therapy. Due to persistent bradycardia, he received a dual-chamber cardiac pacemaker without any immediate complications. Three months later, his pacemaker interrogation showed 99% ventricular pacing. We recommend that extra caution should be taken when initiating remdesivir therapy in individuals with baseline conduction abnormalities due to the possibility of persistent bradycardia.