SARS-CoV-2, COVID-19, and inherited arrhythmia syndromes

Abstract

Ever since the first case was reported at the end of 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the associated coronavirus disease 2019 (COVID-19) has become a serious threat to public health globally in short time. At this point in time, there is no proven effective therapy. The interactions with concomitant disease are largely unknown, and that may be particularly pertinent to inherited arrhythmia syndrome. An arrhythmogenic effect of COVID-19 can be expected, potentially contributing to disease outcome. This may be of importance for patients with an increased risk of cardiac arrhythmias, either secondary to acquired conditions or comorbidities or consequent to inherited syndromes. Management of patients with inherited arrhythmia syndromes such as long QT syndrome, Brugada syndrome, short QT syndrome, and catecholaminergic polymorphic ventricular tachycardia in the setting of the COVID-19 pandemic may prove particularly challenging. Depending on the inherited defect involved, these patients may be susceptible to proarrhythmic effects of COVID-19-related issues such as fever, stress, electrolyte disturbances, and use of antiviral drugs. Here, we describe the potential COVID-19-associated risks and therapeutic considerations for patients with distinct inherited arrhythmia syndromes and provide recommendations, pending local possibilities, for their monitoring and management during this pandemic.

Keywords: Brugada syndrome; COVID-19; Catecholaminergic polymorphic ventricular tachycardia; Long QT syndrome; SARS-CoV-2; Short QT syndrome.

Figure 1

Flowchart of the proposed guidance for corrected QT (QTc) interval monitoring in patients receiving (hydroxy-)chloroquine and/or antiviral drugs and/or azathromycin. It should be noted that not every patient with long QT syndrome (LQTS) has the same risk. The length of the QTc interval is of importance (as is implicit in the flowchart), but also sex, age, and genotype are important. Patients with LQTS type 2 may be at higher risk than patients with LQTS type 1, for example. The consulted cardiologist should have sufficient experience with QT-related arrhythmic problems. ECG = electrocardiography.