COVID-19 Management and Arrhythmia: Risks and Challenges for Clinicians Treating Patients Affected by SARS-CoV-2.

Area of Science:

• Pharmacology
• Cardiology
• Infectious Diseases

Background:

• The COVID-19 pandemic necessitates novel therapeutic approaches.
• Patients with COVID-19 are susceptible to arrhythmias due to comorbidities, polypharmacy, and the disease itself.
• Certain medications used during the pandemic can be pro-arrhythmic, especially in combination.

Purpose of the Study:

• To highlight the risk of drug-induced QT interval prolongation in COVID-19 patients.
• To explain the mechanism of hERG channel inhibition by pro-arrhythmic drugs.
• To emphasize the potential for synergistic effects of multiple hERG-blocking agents.

Main Methods:

• Review of existing literature on drug-induced QT prolongation.
• Analysis of the mechanisms of hERG channel interaction with various medications.
• Assessment of the combined effects of multiple drugs on cardiac electrophysiology.

Main Results:

• Drug-induced QT prolongation is a significant concern in COVID-19 patients.
• Inhibition of the hERG potassium channel is a primary mechanism for QT prolongation.
• Concurrent use of multiple hERG-blocking drugs can lead to synergistic pro-arrhythmic effects.

Conclusions:

• Understanding the risks of pro-arrhythmic medications is crucial for managing COVID-19 patients.
• Informed therapeutic decisions and vigilant monitoring are essential to prevent arrhythmias.
• Minimizing the use of combined hERG-blocking agents can improve patient safety and reduce the risk of Torsades de Pointes.