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Arrhythmias and COVID-19: A Review

State-of-the-Art Review

J Am Coll Cardiol EP, 6 (9) 1193–1204
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Central Illustration

Abstract

Current understanding of the impact of coronavirus disease-2019 (COVID-19) on arrhythmias continues to evolve as new data emerge. Cardiac arrhythmias are more common in critically ill COVID-19 patients. The potential mechanisms that could result in arrhythmogenesis among COVID-19 patients include hypoxia caused by direct viral tissue involvement of lungs, myocarditis, abnormal host immune response, myocardial ischemia, myocardial strain, electrolyte derangements, intravascular volume imbalances, and drug sides effects. To manage these arrhythmias, it is imperative to increase the awareness of potential drug-drug interactions, to monitor QTc prolongation while receiving COVID therapy and provide special considerations for patients with inherited arrhythmia syndromes. It is also crucial to minimize exposure to COVID-19 infection by stratifying the need for intervention and using telemedicine. As COVID-19 infection continues to prevail with a potential for future surges, more data are required to better understand pathophysiology and to validate management strategies.

Highlights

Cardiac arrhythmias are more common in critically ill COVID-19 patients.

Arrhythmias occur not only as a result of direct viral effect, but also due to systemic illness and drug interactions.

Management strategies to minimize the impact on arrhythmias and exposure to COVID-19 infection are imperative.

More data are required to better understand the pathophysiology and to validate management strategies.

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