COVID-19 and Cardiac Arrhythmias
Martin Duckheim1, Jürgen Schreieck1
1Innere Medizin III, Department of Cardiology and Angiology, Eberhard Karls Universität Tübingen, Tübingen, Germany.
Insights
COVID-19 patients frequently experience cardiac arrhythmias, like atrial fibrillation (AF), which are linked to worse outcomes. Understanding mechanisms and adapting management are crucial for these heart rhythm disorders.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- The COVID-19 pandemic has led to millions of cases globally, with some patients experiencing severe or fatal outcomes.
- Myocardial injury and cardiac arrhythmias are common complications in critically ill COVID-19 patients.
- Cardiac arrhythmias in COVID-19 are associated with myocardial involvement and disease severity.
Purpose of the Study:
- To review potential mechanisms, incidence, and treatment options for cardiac arrhythmias in COVID-19 patients.
- To synthesize current literature on heart rhythm disorders in the context of COVID-19.
- To identify knowledge gaps and suggest future research directions.
Main Methods:
- Literature research conducted using MESH database and the National Library of Medicine.
- Systematic review of studies focusing on cardiac arrhythmias in COVID-19 patients.
- Analysis of reported mechanisms, incidence rates, and management strategies.
Main Results:
- Common arrhythmias include sinus tachycardia, atrial fibrillation (AF), ventricular tachycardia (VT), ventricular fibrillation (VF), and QTc prolongation.
- Atrial fibrillation (AF) is the most frequent arrhythmia, with new-onset AF in ~10% and recurrence in 23-33% of patients.
- Ventricular tachycardia (VT) or ventricular fibrillation (VF) occurred in 5.9% of hospitalized patients; both are associated with worse outcomes.
- Mechanisms include hypoxia, myocarditis, myocardial ischemia, and abnormal immune responses.
- QT-prolonging drugs are less implicated now as they are not recommended.
Conclusions:
- Cardiac arrhythmias, particularly AF and VT, are significant complications of COVID-19, correlating with poorer prognosis.
- Multiple pathophysiological pathways contribute to arrhythmia development in COVID-19.
- Acute management requires adaptation due to healthcare personnel exposure concerns, and more prospective data are needed.
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.
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