Characteristics of bradyarrhythmia in patients with COVID‐19: Systematic scoping review

Nagamine, Todd; Randhawa, Sandeep; Nishimura, Yoshito; Huang, Ricky; Leesutipornchai, Thiratest; Benavente, Kevin; Yoshimura, Stephanie; Zhang, James; Kanitsorphan, Chanavuth

doi:10.1111/pace.14466

Cited by 9 publications

(10 citation statements)

References 67 publications

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“…A high incidence of arrhythmias was also reported in COVID-19 patients admitted to the intensive care unit, varying between ∼17%( 4, 65 ) and 44% ( 66, 67 ), with many patients displaying AV block, bradycardia and relative bradycardia( 68–71 ), associated with worse prognosis( 70 ). In one study of COVID-19 patients with bradycardias, complete heart block was highly prevalent and pacemaker implantation was required in 76% of these cases( 72 ). Arrhythmias involving impaired CCS activity are also significantly increased in patients suffering from long COVID syndrome (also known as post-acute sequelae of COVID-19 or PASC).…”

Section: Discussionmentioning

confidence: 94%

“…Similarly, a worldwide survey reported that arrhythmias occurred in ~18% of COVID-19 patients (64), with the majority developing atrial arrhythmias (fibrillation or flutter), ~23% developing bradyarrhythmia (sinus pauses or AV block), and ~20% showing ventricular tachyarrhythmias (VT or VF). A high incidence of arrhythmias was also reported in COVID-19 patients admitted to the intensive care unit, varying between ~17%(4, 65) and 44% (66,67), with many patients displaying AV block, bradycardia and relative bradycardia (68)(69)(70)(71), associated with worse prognosis (70). In one study of COVID-19 patients with bradycardias, complete heart block was highly prevalent and pacemaker implantation was required in 76% of these cases (72).…”

Section: Cardiovascular Consequences Of Covid-19mentioning

confidence: 99%

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Innate Immune Activation and Mitochondrial ROS Invoke Persistent Cardiac Conduction System Dysfunction after COVID-19

Ashok,

Liu,

Criscione

et al. 2024

Preprint

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BackgroundCardiac risk rises during acute SARS-CoV-2 infection and in long COVID syndrome in humans, but the mechanisms behind COVID-19-linked arrhythmias are unknown. This study explores the acute and long term effects of SARS-CoV-2 on the cardiac conduction system (CCS) in a hamster model of COVID-19.MethodsRadiotelemetry in conscious animals was used to non-invasively record electrocardiograms and subpleural pressures after intranasal SARS-CoV-2 infection. Cardiac cytokines, interferon-stimulated gene expression, and macrophage infiltration of the CCS, were assessed at 4 days and 4 weeks post-infection. A double-stranded RNA mimetic, polyinosinic:polycytidylic acid (PIC), was used in vivo and in vitro to activate viral pattern recognition receptors in the absence of SARS-CoV-2 infection.ResultsCOVID-19 induced pronounced tachypnea and severe cardiac conduction system (CCS) dysfunction, spanning from bradycardia to persistent atrioventricular block, although no viral protein expression was detected in the heart. Arrhythmias developed rapidly, partially reversed, and then redeveloped after the pulmonary infection was resolved, indicating persistent CCS injury. Increased cardiac cytokines, interferon-stimulated gene expression, and macrophage remodeling in the CCS accompanied the electrophysiological abnormalities. Interestingly, the arrhythmia phenotype was reproduced by cardiac injection of PIC in the absence of virus, indicating that innate immune activation was sufficient to drive the response. PIC also strongly induced cytokine secretion and robust interferon signaling in hearts, human iPSC-derived cardiomyocytes (hiPSC-CMs), and engineered heart tissues, accompanied by alterations in electrical and Ca2+handling properties. Importantly, the pulmonary and cardiac effects of COVID-19 were blunted by in vivo inhibition of JAK/STAT signaling or by a mitochondrially-targeted antioxidant.ConclusionsThe findings indicate that long term dysfunction and immune cell remodeling of the CCS is induced by COVID-19, arising indirectly from oxidative stress and excessive activation of cardiac innate immune responses during infection, with implications for long COVID Syndrome.

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Section: Discussionmentioning

confidence: 94%

Section: Cardiovascular Consequences Of Covid-19mentioning

confidence: 99%

Innate Immune Activation and Mitochondrial ROS Invoke Persistent Cardiac Conduction System Dysfunction after COVID-19

Ashok,

Liu,

Criscione

et al. 2024

Preprint

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“…We performed extensive search on MEDLINE and EMBASE for articles from the inception of the databases to February 20, 2022. We placed no filters for designs of studies and chief languages used as of our previous systematic review 17 . We also manually screened reference lists of every article to look for additional relevant articles using the reference lists that satisfied the eligibility criteria.…”

Section: Methodsmentioning

confidence: 99%

“…We placed no filters for designs of studies and chief languages used as of our previous systematic review. 17 We also manually screened reference lists of every article to look for additional relevant articles using the reference lists that satisfied the eligibility criteria. Our search strategy involved pertinent keywords including "marginal zone lymphoma," and "IgG4."…”

Section: Search Strategymentioning

confidence: 99%

Clinical characteristics and outcomes of IgG4‐positive marginal zone lymphoma: Systematic scoping review

Nishimura

Wien

Nishimura

et al. 2022

Pathology International

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Immunoglobulin G4 (IgG4)‐positive marginal zone lymphoma (MZL) is rare and undefined. It is unclear whether IgG4‐positive MZLs have as favorable an outcome as MZLs in general. Also, correlation with IgG4‐related disease (IgG4‐RD) and IgG4‐positive MZLs is unknown. Following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for scoping reviews, we searched MEDLINE and EMBASE for all peer‐reviewed articles using keywords including“IgG4” and “marginal zone lymphoma” from their inception to February 20, 2022. Twenty‐two articles, including six observational studies and 24 cases from 16 case reports and case series, were included. Only one study had a comparative group, and the other five were exploratory observational studies. IgG4‐positive MZLs commonly occurred in males (83.3%). It primarily involved ocular adnexa (41.7%) and skin (29.2%). Only 29.2% had concurrent IgG4‐RD, and no expiration was noted. While most cases were treated with excision, resection, or clinical observation, 21.7% received rituximab‐cyclophosphamide, doxorubicin, vincristine, and prednisone as a first‐line treatment. This systematic review summarizes the current understanding of the characteristics of IgG4‐positive MZLs. While there seems to be IgG4‐RD‐related and de novo IgG4‐positive MZLs, future research needs to clearly define MZL with polyclonal IgG4‐positive cells and IgG4‐producing lymphoma. Further studies are critical to clarifying long‐term prognosis and optimal surveillance planning.

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“…Pacemaker insertion was needed in 76% of patients, and 46% required permanent cardiac implants. 64 Patients with COVID-19 with evidence of fevers, inflammation, and hypoxemia develop sinus tachycardia. 63 In a systematic review and meta-analysis of 19 studies including 33,296 hospitalized patients with COVID-19, the diagnosis of atrial fibrillation and/or atrial flutter was associated with poor clinical outcomes.…”

Section: Arrhythmiasmentioning

confidence: 99%

Cardiovascular Complications in Coronavirus Disease 2019—Pathogenesis and Management

Restrepo

Marín‐Corral

Rodriguez

et al. 2023

Semin Respir Crit Care Med

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The coronavirus disease 2019 (COVID-19) pandemic has caused a devastating impact on morbidity and mortality around the world. Severe acute respiratory syndrome-coronavirus-2 has a characteristic tropism for the cardiovascular system by entering the host cells and binding to angiotensin-converting enzyme 2 receptors, which are expressed in different cells, particularly endothelial cells. This endothelial injury is linked by a direct intracellular viral invasion leading to inflammation, microthrombosis, and angiogenesis. COVID-19 has been associated with acute myocarditis, cardiac arrhythmias, new onset or worsening heart failure, ischemic heart disease, stroke, and thromboembolic disease. This review summarizes key relevant literature regarding the epidemiology, diagnosis, treatment, and preventive measures related to cardiovascular complications in the setting of COVID-19.

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Characteristics of bradyarrhythmia in patients with COVID‐19: Systematic scoping review

Cited by 9 publications

References 67 publications

Innate Immune Activation and Mitochondrial ROS Invoke Persistent Cardiac Conduction System Dysfunction after COVID-19

Innate Immune Activation and Mitochondrial ROS Invoke Persistent Cardiac Conduction System Dysfunction after COVID-19

Clinical characteristics and outcomes of IgG4‐positive marginal zone lymphoma: Systematic scoping review

Cardiovascular Complications in Coronavirus Disease 2019—Pathogenesis and Management

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