Management of Arrhythmias Associated with COVID-19
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INVASIVE ELECTROPHYSIOLOGY AND PACING (E. KEVIN HEIST, SECTION EDITOR)
Management of Arrhythmias Associated with COVID-19 Amar D. Desai 1 & Brian C. Boursiquot 1 & Lea Melki 1 & Elaine Y. Wan 1,2 Accepted: 11 November 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Cardiac arrhythmias are known complications in patients with COVID-19 infection that may persist even after recovery from infection. A review of the spectrum of cardiac arrhythmias due to COVID-19 infection and current guidelines and assessment or risk and benefit of management considerations is necessary as the population of patients infected and covering from COVID-19 continues to grow. Recent Findings Cardiac arrhythmias such as atrial fibrillation, supraventricular tachycardia, complete heart block, and ventricular tachycardia occur in patients infected, recovering and recovered from COVID-19. Summary Personalized care while balancing risk/benefit of medical or invasive therapy is necessary to improve care of patients with arrhythmias. Providers must provide thorough follow-up care and use necessary precaution while caring for COVID-19 patients. Keywords Sars-CoV-2 . COVID-19 . Cardiac arrhythmias
Introduction SARS-CoV-2, the severe acute respiratory syndrome coronavirus 2, responsible for COVID-19, has infected over 37 million people globally and almost 8 million people in the USA alone [1]. While the primary symptoms of COVID-19 may be respiratory in nature for the vast majority of cases, several studies have pointed to extrapulmonary effects of the virus [2]. This phenomenon is likely observed due to the cumulative effects of the hyperinflammatory response of the body and the omnipresence in major organs of the angiotensin-converting This article is part of the Topical Collection on Invasive Electrophysiology and Pacing * Elaine Y. Wan [email protected] Amar D. Desai [email protected] Brian C. Boursiquot [email protected] Lea Melki [email protected] 1
Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
2
Cardiology and Cardiac Electrophysiology, Columbia University, 177 Fort Washington Avenue, New York, NY 10032, USA
enzyme 2 (ACE2) cellular receptor that SARS-CoV-2 uses for cell entry [3]. Of all systems which may be affected by the virus, possibly the most common extrapulmonary complications can be observed in the cardiovascular system, with these complications including myocardial injury, cardiomyopathy, acute coronary syndrome, cardiogenic shock, acute cor pulmonale, thrombotic complications, and arrhythmias [4••, 5]. Herein, we describe the signs, symptoms, and pathophysiology of cardiac arrhythmia in COVID-19 (Table 1). SARS-CoV2 infection may cause deleterious cardiovascular effects manifested as cardiac enzyme release and a heightened systemic inflammatory response, which has noted to include elevations in ferritin, lactate dehydrogenase (
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