COVID-19 and Cardiac Arrhythmias: A Review of the Literature

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of the ongoing coronavirus disease 2019 (COVID-19) pandemic. There are many documented COVID-19-related cardiac complications, one of the most feared is arrhythmia. Many ongoing studies are evaluating the pathophysiology of COVID-19-induced arrhythmia. However, our knowledge about the exact mechanism of the latter is still limited. The underlying possible mechanisms could be related to direct or indirect endomyocardial tissue damage. It is also noted in several studies that cardiac arrhythmias are the consequence of systemic illness, proarrhythmic medications, and electrolytes imbalances in hospitalized patients and not solely the direct effects of COVID-19 infection. In this review article, we present the different aspects of arrhythmias in COVID patients, possible associated conditions, and triggers.

Covid-19: pharmacotherapeutic insights on various curative approaches in terms of vulnerability, comorbidities, and vaccination

“…Arrhythmia can also be produced by CD8 + T cells migrating into the heart and causing cardiac inflammation through cell-mediated cytotoxicity. This is caused mainly by lymphocyte overactivation due to cytokine storm, which further overproduces proinflammatory mediators, leading to a positive feedback loop of immunological activation and cardiac injury (Akkawi and Ghazal 2021 ; Coromilas et al 2021 ). Coexisting electrolyte disarray, hypoxia, endogenous catecholamine adrenergic status, and the use of arrhythmogenic drugs such as azithromycin, hydroxychloroquine make it elusive to find the direct and indirect presence of COVID-19 on cardiac arrhythmias (Gopinathannair et al 2020 ; Coromilas et al 2021 ).…”

“…According to a case series reported by Liu et al, palpitations were recorded as the initial symptom in 7.3% SARS-CoV-2-positive patients admitted to tertiary hospitals in Hubei province in January 2020 (Liu et al 2020 ). Moreover, patients with underlying CVD had higher troponin-T (TnT) levels, which led to more significant problems such as malignant arrhythmias and ventricular fibrillation (Akkawi and Ghazal 2021 ).…”

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

“…This is not surprising, as acute infections are known to be a potential cardiovascular disease trigger ( 7 ). Arrhythmias are related to the severity of COVID-19 disease and could be the result of direct or indirect damage to myocardial tissue caused by multiple mechanisms ( 8 ). Pulmonary damage and its progression determine the prognosis during COVID-19 infection ( 9 ) and inflammation in pulmonary infections has been described as a trigger factor for arrhythmias ( 10 ).…”

The potential role of SARS‐CoV‐2 infection in acute coronary syndrome and type 2 myocardial infarction (T2MI): Intertwining spread

“…This will result in AngII accumulation and consequently, adverse myocardial remodeling mediated by its action on ACE1 receptors. 83 Nevertheless, major coronary vessels with atherosclerotic plaques develop minor inflammation during COVID-19 since coronary arteries are not initially and primarily targeted by SARS-CoV-2 due to low expression of ACE2 in coronary vessels. 84 Also, acute myocardial injury is an independent risk factor for increased mortality in COVID-19 patients since cTn serum levels in COVID-19 patients at ICU correlate with high mortality.…”