# Paroxysmal Atrial Fibrillation with Rapid Ventricular Response Following COVID-19 Nasopharyngeal Swab: A Case Report

## TL;DR

A healthy healthcare worker developed a sudden heart rhythm issue after a COVID-19 nasal swab, possibly due to a reflex triggered by the procedure.

## Contribution

Reports a rare case linking nasal swabbing to paroxysmal atrial fibrillation via the trigeminocardiac reflex.

## Key findings

- Atrial fibrillation occurred after a nasal swab in a healthy individual.
- The event may be linked to an exaggerated vagal response via the trigeminocardiac reflex.
- Alternative, less invasive testing methods may be safer for susceptible individuals.

## Abstract

Nasopharyngeal (NP) swab sampling is a simple procedure that has become extremely popular in the coronavirus disease 2019 (COVID-19) era, with hundreds of million specimens collected every day. However, rare but serious complications have been reported following NP swab acquisition. Here we present a case of paroxysmal atrial fibrillation associated with NP specimen collection in a healthy healthcare provider undergoing COVID-19 testing during departmental screening. This response may have been caused by an exaggerated vagal tone triggered by the trigeminocardiac reflex. Less invasive collection methods, such as saliva testing, may be warranted in predisposed individuals.