Section 3.1.2: Arrhythmia (from DOI: 10.1007/s11886-020-01293-2)
From publication: "Cardiovascular Risks in Patients with COVID-19: Potential Mechanisms and Areas of Uncertainty" published as Curr Cardiol Rep; 2020 04 29 ; 22 (5) 34. DOI: https://doi.org/10.1007/s11886-020-01293-2
Section 3.1.2: Arrhythmia
A published study and additional anecdotal reports have highlighted the presence of arrhythmia and even sudden cardiac death in critically ill COVID-19 patients. The first case series out of Wuhan documented 16.7% and 44% incidence of arrhythmia in those hospitalized for COVID-19 and admitted to the ICU respectively. Unfortunately, the exact nature of the arrhythmias was not detailed in this study. Interestingly, a high incidence of arrhythmias was not reported in several subsequent larger case series from China . One would expect a majority of the reported arrhythmias are atrial, as similarly elevated rates of atrial arrhythmia were seen in longitudinal studies on Medicare patients hospitalized with sepsis. It remains to be determined whether a significant portion of COVID-19 patients have hemodynamically significant ventricular arrhythmias. The high prevalence of myocardial injury may itself increase life-threatening arrhythmias and contribute to worse outcomes. More definitive epidemiologic data is urgently needed. Of note, some of the therapies empirically used to treat SARS-CoV-2 infections such as chloroquine, have known effects on myocyte repolarization, resulting in increased risk of QT prolongation and subsequent arrhythmia. Given the high incidence of electrolyte abnormalities in ill patients, high vigilance by the treatment teams is required to avoid iatrogenic harm.
