0564: Inappropriate bradycardia in patients with Ebola virus disease. About a cohort of nine consecutive patients in Conakry, Guinea

Background West African outbreak of Ebola virus disease (EVD) currently affects urban areas in Guinea. Although some cases of bradycardia have been reported since the first Ebola outbreak in 1976, they have never been documented to our knowledge. Methods we analyse heart rate (HR) for our cohort of nine consecutive patients (5 males, mean age: 38.7 years [range: 27-62]) testing positive for EVD and admitted to the EVD Treatment Centre (EVDTC) in Conakry, Guinea. Treatment and care were standardized, all healthcare workers by wearing personal protective equipment. ECG was recorded if HR was <50 bpm. Eight patients recovered. Mean hospitalization duration was 11.1 days [range: 2-21]. No patient had cardiovascular risk factor or cardiac treatment. Results we observed significant sinus bradycardia (<45 bpm) in one patient, without conductive disturbance or repolarization abnormalities on ECG, whereas mean HR recorded no/moderate tachycardia at admission (mean [±SD], 76±23 beats per minute [bpm], range: 43-107) for all patients. During follow-up, there is a trend to significant increase in mean HR between Day 1 and Day 11 (89±19 bpm) [Wilcoxon test: p=0.051]. Discussion Despite several factors of tachycardia (stress, fever, pain, infection, dehydration), we can note a relative bradycardia for all patients, with a paradoxical increase in HR during hospitalization. Clinical inappropriate bradycardia or dissociated pulse was previously described during the first Ebola outbreak in 1976, as in the current epidemic. The hypothesis for toxin inducing bradycardia in EVD has never been documented. Despite the low number of patients in this cohort, we therefore hypothesized the possibility of a central neurological cause, due to encephalitis. Indeed, most of our patients presented significant clinical encephalitis signs. Conclusion patients infected with Ebola virus may have an inappropriate bradycardia. The cause of this bradycardia could be multifactorial. Abstract 0564 – Figure: Heart rate in patients with Ebola virus disease Figure options Download full-size image Download high-quality image (124 K) Download as PowerPoint slide