COVID-19-related arrhythmias and the possible effects of ranolazine

Abstract

The COVID-19 pandemic has become a burden to the global healthcare community. Despite the severity of the complications associated with COVID-19, no antiviral agent is yet available for the treatment of this disease. Several studies have reported arrhythmias as one of the numerous manifestations associated with COVID-19 infection. Clinicians use different therapeutic agents in the management of COVID-19 patients with arrhythmias, apart from ranolazine; however, some of these drugs are administered with caution because of their significant side effects. In this study, we reviewed the potential antiarrhythmic effects of ranolazine in the management of cardiac arrhythmias associated with COVID-19. Ranolazine is a second-line drug approved for the treatment of chronic stable angina pectoris. Previous studies have shown that ranolazine produces its beneficial cardiac effects without any significant impact on the body's hemodynamics; hence, blood pressure is not altered. Due to its reduced side effects, ranolazine may be more effective than other drugs in producing the desired relief from COVID-19 related arrhythmias, since it produces its antiarrhythmic effect by modulating sodium, potassium and calcium channels, and suppressing cytokine expression.

Keywords: Arrhythmias; COVID-19; Cytokine; Ranolazine; SARS-CoV-2.

Fig. 1

SARS-CoV-2 triggers cardiac arrhythmias by disrupting the ion channels to cause increase in intracellular calcium and sodium levels via cytokine storm, and hypoxia-induced myocardial damage. Ranolazine shows its antiarrhythmic effect by blocking both hypoxia-induced increase in late sodium current (late I_Na) which prolongs action potential duration, and the cytokine storm; ultimately reducing damage to the cardiac tissues.