Ventricular Arrhythmia and COVID-19 Vaccine-associated Myocarditis

Aim. To study the spectrum of rhythm and conduction disorders in patients with arrhythmic variant of postcovid myocarditis and determine the treatment approaches.Methods. The study included 23 patients with post-COVID-19 по абстракту разное написание. Post-COVID arrhythmias who had at least two of the three Lake-Louise criteria for myocarditis on magnetic resonance imaging of the heart and/or elevated anticardiac antibody (ACA) titers. The period of occurrence of post-COVID arrhythmias was 4.0 [2.0; 8.0] months, from 2 to 34 months. Echocardiography, Holter monitoring, and ACA study were performed. Cardiac magnetic resonance imaging was performed in 70% of patients (n=16). Coronary artery disease was excluded in 9 patients with risk factors.Results. In all patients’ arrhythmias were associated with COVID-19. Rhythm and conduction disturbances occurred within 2 to 34 months after infection. Echocardiography revealed no left ventricle systolic dysfunction. In all patients, an increase in ACA by 3 or more times was noted, in 65.2% (n=15) a specific antinuclear factor (ANF) was detected, reflecting the high immunological activity of myocarditis. Ventricular arrhythmias in most cases were represented by frequent ventricular extrasystole. Among supraventricular arrhythmias, frequent extrasystoles, non-sustained tachycardia, paroxysmal form of atrial fibrillation were detected. In one case, a transient atrioventricular block II-III degree developed. Treatment approaches included antiarrhythmic and immunosuppressive therapy. All patients underwent Holter monitoring, which showed regression of arrhythmias. Patients with high immunological activity of myocarditis underwent immunosuppressive therapy with methylprednisolone 8-16 mg/day (n=13), with moderate - mild immunosuppressive therapy with hydroxychloroquine 200 mg/day (n=10). When controlling the ACA titers, their decrease was noted. The decrease in the specific ANF titer was close to statistically significant (p=0.057). Interventional treatment of arrhythmias was performed in three patients.Conclusions. Arrhythmias that first developed after COVID-19 require the exclusion of subacute/chronic myocarditis that develops 2-8 months after COVID-19. The spectrum of arrhythmias in patients with post-COVID myocarditis is mostly represented by frequent symptomatic extrasystoles. Basic therapy of the arrhythmic variant of post-COVID myocarditis with methylprednisolone and/or hydroxychloroquine makes it possible to increase the effectiveness of antiarrhythmic drugs with the opportunity of their complete withdrawal in some patients.

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Myocardial Infarction Following Vaccination Against COVID-19: A Systematic Review

Rahimi Petrudi,

Abdollahi,

Mirzaii-Dizgah

2023

Ann Mil Health Sci Res

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Context: Several reports have been presented regarding the occurrence of acute myocardial infarction following vaccination against COVID-19. Objectives: The current systemic review tried to review and summarize the published evidence and documents regarding the occurrence of myocardial infarction following various types of anti-COVID-19 vaccines (AstraZeneca and Pfizer) and, finally, take steps to clarify the causes of such incidents. Methods: The relevant databases, including Medline, Web of Knowledge, Google Scholar, Scopus, and Cochrane, were comprehensively searched by the two blinded researchers for all eligible studies based on the considered keywords. Of 76 articles initially collected by database searching, 20 articles were included in the last analysis. Results: The occurrence of acute myocardial infarction was mostly related to SARS-CoV-2-based messenger RNA and viral vector vaccines. This cardiac attack occurred after the first vaccination in 74% of patients affected. The time of occurrence of myocardial infarction was also very different between different types of vaccines and varied between 15 minutes and 21 days after vaccination. Most of the myocardial infarctions that occurred after vaccination were of the ST-segment elevation type (STEMI) (23 of 28 patients). More than two-thirds of myocardial infarction cases occurred in patients who had significant cardiovascular risk profiles (hypertension, diabetes mellitus, and ischemic heart disease). Overall, 22.2% of cases suffering post-vaccination myocardial infarction died within hospitalization. Conclusions: The occurrence of myocardial infarction following the vaccination against COVID-19 is rare, and due to the fatality of this event, it is necessary to modify the biotechnological production of existing vaccines and to accurately evaluate the pathophysiology of this event.

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Ventricular Arrhythmia and COVID-19 Vaccine-associated Myocarditis

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Arrhythmic variant of post-covid myocarditis: spectrum of rhythm and conduction disorders, treatment approaches

Myocardial Infarction Following Vaccination Against COVID-19: A Systematic Review

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