Paroxysmal supra-ventricular ventricular tachycardia after AstraZeneca COVID-19 vaccine injection.

Dear Editor,

A 29-year-old ear-nose-throat (ENT) doctor was presented to our emergency department with fever and chills for one day. He complained of palpitation, headache, chest tightness, and dry coughing after shot of Oxford/AstraZeneca COVID-19 vaccine for one day. He was healthy before except he ever had episode of paroxysmal supraventricular tachycardia (PSVT) when he was a child. Upon physical examination, he had a fever of up to 39 degrees Celsius, a heart rate of 241 beats per minute (BPM), respiratory rate of 18 times per minute, blood pressure: 103/76 mmHg, and saturation of oxygen via pulse oximeter was 99%. Laboratory tests revealed neither leukocytosis nor elevation of cardiac enzymes. Chest X-ray was unremarkable. However, electrocardiography (ECG) showed paroxysmal supraventricular tachycardia (Fig. 1). Intravenous adenosine 6 mg administration and adequate hydration were administered. Then, the follow-up electrocardiography after 6 mg adenosine revealed sinus tachycardia (heart rate: 126 beats per min). After a few hours of observation, he was discharged under stable condition. Oxford/AstraZeneca COVID-19 vaccine may lead to fever, malaise, myalgia, arthralgias, and pain over the injection site. The fever usually occurs within the first two days after vaccination. The incidence rate of fever is 28% of first dose BioNTech/Pfizer and 45% of second dose; 26.7% of Janssen in patients aged 18–59 and 10% aged > 60 years. But no data was available for Moderna and Vaxzevria—AstraZeneca [1]. The fever causes vasodilatation and hypotension and compensation by increasing heart rate to provide higher cardiac output leading to PSVT [2].

Fig. 1

Initial electrocardiography showed paroxysmal supraventricular tachycardia (PSVT), heart rate: 241 beats per min.

Other COVID-19 vaccines related arrhythmia, a US report in November 2021 describing mRNA COVID-19 vaccines happened to mean age of 15.6 ± 1.8 years inducing arrhythmia with a rate of 8% ventricular tachycardia and 3% of complete atrio-ventricular block [3]. Therefore, if a patient is known to have history of PSVT or other kinds of tachyarrhythmias, it is the best policy to lower the body temperature after vaccination if fever occurred. This is the first case of PSVT caused by the Oxford/AstraZeneca COVID-19 vaccine complicated with fever.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Role of funding source

None.

Role in writing

Yi-Tung Lin wrote the draft, discussed with Dr. Pang-Yen Chen, Dr. Yu-Jang Su treated this patient, revised the text and corresponded.

Declaration of competing interest

None