Arrhythmias after SARS-CoV-2 Vaccination in Patients with a Cardiac Implantable Electronic Device: A Multicenter Study

Abstract

One of the most concerning adverse events related to the SARS-CoV-2 vaccination is arrhythmia. To ascertain the relationship between vaccination and arrhythmic events, we studied the occurrence of arrhythmia in patients with cardiac implantable electronic devices (CIEDs) before and after a SARS-CoV-2 vaccination. Patients with CIEDs aged ≥18 who visited the CIED clinic at King Chulalongkorn Memorial Hospital and Vajira hospital from August 2021 to February 2022 were included. Information about the SARS-CoV-2 vaccination and side effects was obtained. One hundred eighty patients were included in our study, which compared the incidence of arrhythmias in the 14 days post-vaccination to the 14 days before vaccination. The median age was 70 years. The number of patients who received one, two, and three doses of the vaccine was 180, 88, and 4, respectively. ChAdOx1 was the primary vaccine used in our institutes, accounting for 86% of vaccinations. The vaccination was significantly associated with a 73% increase incidence of supraventricular tachycardia (SVT). In an adjusted model, factors associated with the incidence of SVT were the post-vaccination period, female sex, increasing BMI, chronic kidney disease, and a history of atrial fibrillation. Increased ventricular arrhythmia (VA) episodes were also associated with the post-vaccination period, female sex, decreasing BMI, and chronic kidney disease, but to a lesser degree than those with SVT episodes. No life-threatening arrhythmia was noted in this study. In conclusion, the incidence of arrhythmia in patients implanted with CIEDs was significantly increased after the SARS-CoV-2 vaccination.

Arrhythmias after COVID-19 Vaccination: Have We Left All Stones Unturned?

“…To ascertain the relationship between vaccination and arrhythmic events, Naruepat Sangpornsuk et al studied the occurrence of arrhythmia in patients with cardiac implantable electronic devices before and after a SARS-CoV-2 vaccination and reported that the incidence of arrhythmia was significantly increased after the SARS-CoV-2 vaccination with a 73% increase in the incidence rate of sopraventricular arrhythmias and a 316% increase in the incidence ratio of ventricular arrhythmias [ 27 ].…”

COVID-19 Vaccines and Atrial Fibrillation: Analysis of the Post-Marketing Pharmacovigilance European Database

“…Recently, attention has also shifted to other, even rarer cardiac adverse events, such as AF following mRNA vaccination [ 15 , 19 , 23 , 29 ]. Considering the important impact of this arrhythmia in terms of hospitalization, morbidity, and mortality [ 30 ], data analysis and insights into the possible relationship between AF and COVID-19 vaccination represent an important research topic.…”

“…AF has also been reported to occur with COVID-19, although its relationship with myocarditis, lung injury, and systemic inflammation status is unclear; interestingly, a study demonstrated increased mortality and prolonged hospitalization in COVID-19 patients who developed AF [ 14 ]. Data on the occurrence of AF following COVID-19 vaccination are still limited [ 15 ]. The analysis of data from spontaneous reporting systems offers a fundamental tool allowing the identification of new safety signals, which subsequently require further investigations through different methodological approaches [ 16 ].…”

Cardiac Arrhythmias in Post-COVID Syndrome: Prevalence, Pathology, Diagnosis, and Treatment

“…By contrast to the general population, the incidence of arrhythmias significantly increases in patients with cardiac implantable electronic devices (CIED) after SARS-CoV-2 vaccination. Thus, a 73% increase in the incidence of supraventricular tachycardias and ventricular arrhythmias was observed among 180 patients with CIED during the post-vaccination period, but no life-threatening arrhythmias were noted [ 91 ].…”