COVID-19 and Cardiac Arrhythmias

Parashar, Nitin Kumar Shekhar Kunal Mahla Himanshu Gupta Kashish Pathak Vijay

Coronavirus disease-2019 (COVID-19) has impacted the global population, leading to a pandemic, the scale of which the world has never experienced before. This novel coronavirus not only involves the respiratory system, but also affects the heart, leading to significant morbidity and mortality. Arrhythmias in COVID-19 are increasingly being documented and seem to have a prognostic significance, especially in critically ill patients. In patients with COVID-19, a variety of arrhythmias have been reported, ranging from the benign to potentially life-threatening. Multiple mechanisms, such as myocarditis, hypoxia, electrolyte disturbances and QT interval-prolonging drugs (e.g. hydroxychloroquine), are responsible for arrhythmias in patients with COVID-19. The prevalence of cardiac arrhythmias in patients with COVID-19 ranges from 3.6% to 60%, with sinus tachycardia being the most common rhythm abnormality. Other rhythm abnormalities, such as sinus bradycardia, atrial arrhythmias and complete heart block, have also been reported. Malignant ventricular arrhythmias, especially in patients with COVID-19 with multiple comorbidities, portend a bad prognosis. Additionally, the use of QT interval-prolonging drugs, such as hydroxychloroquine or azithromycin, increases the risk of torsades de pointes. Hence, there is a need for continuous rhythm monitoring, with prompt recognition of arrhythmias in critically ill patients and those on QT-prolonging medications. Management of these arrhythmias is similar to those in patients without COVID-19, with a focus on correcting reversible causes and maintaining haemodynamic stability.