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Contemporary approach to understand and manage COVID-19-related arrhythmia
Omnia Azmy Nabeh1, Maiada Mohamed Helaly2, Rahma Menshawey3
1Department of Medical Pharmacology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt. omnia.azmy@kasralainy.edu.eg.
Insights
COVID-19 commonly causes arrhythmia due to multifactorial mechanisms. Early monitoring and potential drug interventions are crucial for preventing lethal outcomes in at-risk patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- Arrhythmia is a frequent complication of COVID-19, affecting nearly one-third of patients, particularly those in intensive care.
- Multiple factors contribute to COVID-19-associated arrhythmias, including hypoxia, myocarditis, cytokine storm, and drug effects.
- Pre-existing cardiac conditions significantly elevate the risk of severe arrhythmias and adverse outcomes in COVID-19 patients.
Purpose of the Study:
- To highlight the multifactorial etiology of arrhythmias in COVID-19 patients.
- To emphasize the need for expanded management strategies beyond viral infection control.
- To explore potential pharmacological interventions and monitoring parameters for preventing COVID-19-related arrhythmias.
Main Methods:
- Review of existing literature on COVID-19 and cardiac complications.
- Analysis of predisposing mechanisms for arrhythmia in COVID-19.
- Discussion of potential therapeutic agents and monitoring strategies.
Main Results:
- Identified key contributing factors: catecholamine surge, hypoxia, myocarditis, cytokine storm, QTc prolongation, electrolyte imbalance, and drug toxicity.
- Highlighted increased risk in patients with pre-existing heart conditions like ischemia, heart failure, and cardiomyopathy.
- Proposed monitoring of unbound free fatty acids, electrolytes, troponin, and QTc intervals.
Conclusions:
- COVID-19 patient management must incorporate arrhythmia prevention strategies.
- Investigating drugs like adrenergic antagonists, trimetazidine, and ranolazine may be beneficial.
- Proactive monitoring is essential for identifying patients at risk of life-threatening arrhythmic events.
Abstract:
Arrhythmia, one of the most common complications of COVID-19, was reported in nearly one-third of diagnosed COVID-19 patients, with higher prevalence rate among ICU admitted patients. The underlying etiology for arrhythmia in these cases are mostly multifactorial as those patients may suffer from one or more of the following predisposing mechanisms; catecholamine surge, hypoxia, myocarditis, cytokine storm, QTc prolongation, electrolyte disturbance, and pro-arrhythmic drugs usage. Obviously, the risk for arrhythmia and the associated lethal outcome would rise dramatically among patients with preexisting cardiac disease such as myocardial ischemia, heart failure, cardiomyopathy, and hereditary arrhythmias. Considering all of these variables, the management strategy of COVID-19 patients should expand from managing a viral infection and related host immune response to include the prevention of predictable causes for arrhythmia. This may necessitate the need to investigate the role of some drugs that modulate the pathway of arrhythmia generation. Of these drugs, we discuss the potential role of adrenergic antagonists, trimetazidine, ranolazine, and the debatable angiotensin converting enzyme inhibitors drugs. We also recommend monitoring the level of: unbound free fatty acids, serum electrolytes, troponin, and QTc (even in the absence of apparent pro-arrhythmic drug use) as these may be the only indicators for patients at risk for arrhythmic complications.
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