COVID-19 infection and cardiac arrhythmias

Abstract

As the coronavirus 2019 (COVID-19) pandemic marches unrelentingly, more patients with cardiac arrhythmias are emerging due to the effects of the virus on the respiratory and cardiovascular (CV) systems and the systemic inflammation that it incurs, and also as a result of the proarrhythmic effects of COVID-19 pharmacotherapies and other drug interactions and the associated autonomic imbalance that enhance arrhythmogenicity. The most worrisome of all arrhythmogenic mechanisms is the QT prolonging effect of various anti-COVID pharmacotherapies that can lead to polymorphic ventricular tachycardia in the form of torsade des pointes and sudden cardiac death. It is therefore imperative to monitor the QT interval during treatment; however, conventional approaches to such monitoring increase the transmission risk for the staff and strain the health system. Hence, there is dire need for contactless monitoring and telemetry for inpatients, especially those admitted to the intensive care unit, as well as for outpatients needing continued management. In this context, recent technological advances have ushered in a new era in implementing digital health monitoring tools that circumvent these obstacles. All these issues are herein discussed and a large body of recent relevant data are reviewed.

Keywords: Atrial fibrillation; COVID-19; Cardiac arrhythmias; Long QT syndrome; Myocarditis; SARS-CoV-2; Sudden cardiac death; Torsade des pointes; Ventricular fibrillation; Ventricular tachycardia.

Fig. 1

The schema illustrates the various arrhythmias encountered in patients with COVID-19 infection as a consequence of the virus infection affecting the heart and lung and/or producing systemic inflammation, the adverse (proarrhythmic) effects of COVID therapies and the drug-drug interactions that may occur (see text for discussion). AF = atrial fibrillation; AVB = atrioventricular block; LQT = long QT interval; PEA = pulseless electrical activity; SB = sinus bradycardia; SCD = sudden cardiac death; SNS = sympathetic nervous system; STach = sinus tachycardia; TdP = torsade des pointes; VAs = ventricular arrhythmias; VF = ventricular fibrillation; VT = ventricular tachycardia.