Author + information
- Received July 6, 2020
- Revision received July 31, 2020
- Accepted August 4, 2020
- Published online September 21, 2020.
- Parinita Dherange, MBBSa,
- Joshua Lang, MDa,
- Pierre Qian, MBBS, PhDa,
- Blake Oberfeld, BSb,
- William H. Sauer, MDa,
- Bruce Koplan, MDa and
- Usha Tedrow, MD, MSca,∗ ()
- aDivision of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- bDivision of Cardiovascular Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Usha Tedrow, Department of Clinical Cardiac Electrophysiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, Massachusetts 02115.
• 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.
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.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Bruce Lerman, MD, served as Guest Editor for this paper. William Stevenson, MD, served as Guest Editor-in-Chief for this paper.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received July 6, 2020.
- Revision received July 31, 2020.
- Accepted August 4, 2020.
- Central Illustration
- Data on Arrhythmia From Previous Epidemics and the Current COVID-19 Outbreak
- Possible Mechanism for Arrhythmogenesis
- Management of Arrhythmias With COVID-19
- Ventricular Arrhythmias
- Channelopathies and Inherited Arrhythmia Syndrome