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

Abstract

An increase in post-COVID patients with late sequelae of acute COVID-19 infection is emerging as an ongoing challenge for physicians and healthcare professionals. Since the beginning of the pandemic, it has rapidly become evident that the acute infection is not limited to the respiratory tract but that several organs, including the cardiovascular system, can be affected. Moreover, in a significant proportion of patients (ranging from about 10 to up to 50%) with former COVID-19, cardiopulmonary symptoms such as dyspnea, palpitations, restricted physical capacity, and cardiac arrhythmias can persist weeks and months after the acute SARS-CoV-2 infection. The spectrum of COVID-19-associated arrhythmias is rather wide, most likely due to various pathomechanisms. In this article, the prevalence of cardiac arrhythmias and underlying pathologies are reviewed, including direct myocardial injury and abnormal consequences with an impact on cardiac electric instability. The hyperinflammatory reaction of the host immune system is specifically considered. Moreover, several distinct rhythm disorders occurring in post-COVID patients are discussed with regard to their clinical management.

Post-COVID Syndrome in Adults—An Overview

“…Some of the symptoms displayed in Figure 1 are likely to be due to dysautonomia [ 14 ]. Autonomic dysfunction appears to be a rather frequent feature of the post-COVID condition and can cause, for example, orthostatic intolerance syndromes, neurogenic orthostatic hypotension, labile blood pressure, postural orthostatic tachycardia syndrome [ 15 ], and other more non-specific sequelae, such as gastrointestinal symptoms (e.g., abdominal pain, vomiting, constipation, or loose stools), flushing, sweating abnormalities, or temperature intolerance [ 14 ].…”

Desenvolvimento de arritmias cardíacas em pacientes com Síndrome long COVID-19 , uma revisão sistemática da literatura

“…However, the mechanisms triggering cardiac arrhythmias after COVID-19 are not yet well defined, but a chronic inflammatory response and a possible autoimmune response to cardiac antigens due to molecular mimicry are suspected [11]. The spectrum of possible cardiac arrhythmias is broad and ranges from benign ventricular extrasystoles to atrial fibrillation and sudden death due to ventricular arrhythmias, probably due to different pathogenic mechanisms that require further exploration [14].…”

Hybrid surgical-catheter epicardial ablation of recurrent ventricular tachycardia in an arrhythmogenic cardiomyopathy patient with pericardial adhesions following COVID-19 infection

“…There is increasing evidence that cardiac arrhythmias have emerged as well-documented post–COVID-19 infection sequelae, with an overall prevalence of 10%–20%, particularly in those with pre-existing cardiac structural disease and cardiovascular comorbidities. 14 Frequent PVCs have been reported as the most common ventricular arrhythmia, at 18%, and nonsustained VT at 5%. 14 The proposed mechanisms include varying combinations of ischemia; inflammatory cytokine surge (eg, interleukin-6 and tumor necrosis factor α), which can prolong ventricular action potential, leading to arrhythmogenicity; direct cardiomyocyte injury from myocarditis mediated by surface protein angiotensin-converting enzyme 2 receptor and viral spike protein interaction; and new scar formation.…”