Understanding of COVID-19 Impact on Arrhythmias Evolves With New Data

Understanding of the impact of COVID-19 on arrhythmias is evolving as new data emerges, according to a review paper published Aug. 10 in JACC: Clinical Electrophysiology.

Parinita Dherange, MBBS, et al., highlight the potential mechanisms of arrhythmias in this setting and management of arrhythmias to provide a resource for clinicians during the pandemic. The paper also suggests strategies to minimize exposure to COVID-19. Arrhythmias are more common in critically ill COVID-19 patients, and the increased risk of arrhythmias in COVID-19 patients likely is due to systemic illness rather than a direct effect of the virus, the authors note.

Potential mechanisms for arrhythmias include hypoxia caused by involvement of viral tissue of the lungs, myocarditis, abnormal host immune response, myocardial ischemia, myocardial strain, electrolyte derangements, intravascular volume imbalances, and drug side effects. For management of arrhythmias in COVID-19 patients, the authors note that it is "imperative" to be aware of potential drug-drug interactions, monitor QTc prolongation during COVID treatment, and closely monitor patients with inherited arrhythmia syndromes. In addition, it is critical to minimize exposure to COVID-19 infection, both for patients and health workers, by stratifying the need for intervention and using telemedicine when possible.

Additional data are needed to better understand the pathophysiology of arrhythmias in COVID-19 patients and "validate management strategies," particularly as COVID-19 "continues to prevail with a potential for future surges," the authors conclude.

Keywords: COVID-19, Pandemics, severe acute respiratory syndrome coronavirus 2, Coronavirus, Myocarditis, Critical Illness, Myocardial Ischemia, Arrhythmias, Cardiac, Coronary Artery Disease, Long QT Syndrome, Telemedicine, Electrophysiology

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