COVID-19 and Cardiac Arrhythmias

Abstract

Since the coronavirus disease (COVID-19) pandemic spread unrelentingly all over the world, millions of cases have been reported. Despite a high number of asymptomatic cases, the course of the disease can be serious or even fatal. The affection of the myocardium, called myocardial injury, is caused by multiple triggers. The occurrence of cardiac arrhythmias in COVID-19 patients with myocardial involvement and a critical course is common. In this review, potential mechanisms, incidence, and treatment options for cardiac arrhythmias in COVID-19 patients will be provided by performing a literature research in MESH database and the National Library of Medicine. Common cardiac arrhythmias in COVID-19 patients were sinus tachycardia, atrial fibrillation (AF), ventricular tachycardia (VT), ventricular fibrillation (VF), atrioventricular block, sinusoidal block or QTc prolongation. AF was the most common heart rhythm disorder. About 10% of COVID-19 patients develop new-onset AF and 23 to 33% showed recurrence of AF in patients with known AF. One retrospective trial revealed the incidence of VT or VF to be 5.9% in hospitalized patients. Both AF and VT are clearly associated with worse outcome. Several mechanisms such as hypoxia, myocarditis, myocardial ischemia, or abnormal host immune response, which induce cardiac arrhythmias, have been described. The effect of QT-prolonging drugs in inducing cardiac arrhythmias has become mitigated as these medications are no longer recommended. Acute management of cardiac arrhythmias in COVID-19 patients is affected by the reduction of exposure of health care personnel. More prospective data are desirable to better understand pathophysiology and consecutively adapt management.

Incidence and Predictors of Cardiac Arrhythmias in Patients With COVID-19

“…Coronavirus disease 2019 (COVID-19) is a systemic disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that has been affecting millions of people around the world since December 2019 ( 1 , 2 ). SARS-CoV-2 can cause damage to multiple organs ( 3 ). Detailed mapping of the viral RNA in tissues of 11 deceased patients with COVID-19 has shown cardiovascular dissemination of the virus in all patients ( 4 ).…”

Early Alterations of QTc in Patients with COVID-19 Treated with Hydroxychloroquine or Chloroquine in Libreville, Gabon

“…The median QTc observed at the CHUL could reflect a greater sensitivity of this population to treatment. Some authors showed that cardiac arrythmias in COVID-19 patients with severe or critical disease or with myocardial impact also involve QTc prolongation, while others found that QTc prolongation is rare during COVID-19 but drugs like HCQ and azithromycin are associated with a significant risk of QTc prolongation in SARS-CoV2 infected persons; this risk increases when azithromycin is associated with HCQ [ 23 , 24 , 25 ]. Additionally, COVID-19 patients were shown to be more susceptible to drug-induced QTc prolongation [ 23 , 24 , 25 ].…”

The Effect of COVID-19 on QTc Prolongation

“…However, this hypothesis requires further investigation [20,21]. Theoretically, the mechanisms of cardiac cell injury are hypoxia, myocarditis, myocardial ischemia, or abnormal host immune responses that induce cardiac arrhythmias due to direct viral invasion and inflammation that can result in unstable myocardium and cell membranes and can influence QTc prolongation in COVID-19 [2,22].…”