COVID-19 Collection
Increase in atrial fibrillation–related mortality in the United States during the COVID-19 pandemic
The coronavirus disease 2019 (COVID-19) pandemic has caused more deaths due to both COVID-19 and other clinical conditions such as cardiovascular disease. The relationship between atrial fibrillation (AF) and COVID-19 infection is complex.1 Indeed, AF has found to be associated with a significantly increased risk of short-term mortality in patients infected with severe acute respiratory syndrome coronavirus 2.2 Furthermore, patients with COVID-19 per se have an increased risk of developing AF.3 The aim of the present study was to investigate the trend of AF-related mortality in the United States before and during the COVID-19 pandemic.Effects of COVID-19 pandemic on physical activity in children and young adults with implanted devices
Children and young adults with preexisting cardiovascular disease (CVD) may be disproportionately affected by the collateral health consequences of the coronavirus disease 2019 (COVID-19) pandemic. In addition to a higher risk of morbidity and mortality from COVID-19,1 young persons with CVD may be more susceptible to alterations in physical activity (PA) and poor health outcomes2 owing to the unprecedented loss of structured school days, reduced sports participation, increased screen time, and social isolation.Cardiac arrhythmias in patients hospitalized with COVID-19: The ACOVID study
First reports from the initial epicenter of the coronavirus disease 2019 (COVID-19) outbreak in Wuhan, China included case series of rapid clinical deterioration of seemingly healthy individuals.1,2 Based on a cohort of 138 Chinese patients, 16.7% of patients with COVID-19 suffered from unspecified arrhythmias despite cardiac biomarkers being within normal range. In patients admitted to the intensive care unit (ICU), arrhythmias was reported in 44.4% of the patients. But how diagnosis of arrhythmias were made was not clearly specified.Atrioventricular block after COVID-19: What is the mechanism, site of block, and treatment?
A 49-year-old healthy woman presented with exertional shortness of breath and palpitations of 3 months’ duration. Baseline electrocardiogram (ECG) was normal. Figure 1 shows selected tracings recorded during treadmill stress testing. Transthoracic echocardiogram showed no structural abnormalities. Cardiac positron emission tomogram showed normal myocardial perfusion and no abnormal fluorodeoxyglucose uptake. Antibody titers for Lyme disease were undetectable. Figure 2 shows selected tracings from an invasive electrophysiological (EP) study.Patient perspective: Wearable and digital health tools to support managing our health during the COVID-19 pandemic and beyond
The COVID-19 pandemic has impacted patients’ willingness and ability to engage with healthcare systems. To adapt to the “new normal,” healthcare providers have implemented processes that add more complexity to the process of making an appointment with our physician and entering the office to receive care. We can all agree that the purpose is to keep people safe and reduce the potential for exposure to COVID-19. However, the messaging about COVID-19 and the risk to people with heart disease has created fear and uncertainty for patients.The possible association between COVID-19 and postural tachycardia syndrome
Coronavirus disease 2019 (COVID-19), the illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), involves other body organs besides the lungs. In recovered patients, post-acute sequelae of COVID-19 may include dysautonomia, in which changes in functioning of ≥1 components of the autonomic nervous system (ANS) adversely affect health. This viewpoint focuses on the dysautonomia postural tachycardia syndrome (POTS).EP News: Basic and Translational
Liu et al (Circulation April 15, 2020;doi:10.1161/CIRCULATIONAHA.120.047549, PMID 32293910) provided an overview of coronavirus disease 2019 (COVID-19) that is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The high infectivity of the SARS-CoV-2 virus is contributed by new mutations in the receptor-binding domain and acquisition of a furin cleavage site in the S spike protein. The virus uses the angiotensin-converting enzyme 2 (ACE2) receptor for cell entry, which is mediated by the host cell serine protease TMPRSS2.EP News: Case Reports
Coronavirus disease 2019 (COVID-19) is highly infectious and causes significant strains on health care systems. Routine testing within the hospital is weighed for needed value to minimize exposure to staff. The combination of hydroxychloroquine and azithromycin, both known to prolong the QT interval, was shown to lower the viral load, and early in the COVID-19 pandemic, the drugs were used to try to lower the morbidity and mortality of the infection. Gabriels et al (doi: https://doi.org/10.1016/j.hrcr.2020.03.017 ) shared a case of a 72-year-old woman with paroxysmal atrial fibrillation, treated with flecainide and metoprolol, who presented with dyspnea, cough, fevers, and chills.Genetic susceptibility for COVID-19–associated sudden cardiac death in African Americans
Since emerging from Wuhan, China, in late 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease 2019 (COVID-19), has infected >3.2 million individuals worldwide and ∼1 million in the United States (as of April 29, 2020).1,2 Despite the institution of measures designed to “flatten the curve,” COVID-19 has claimed the lives of >225,000 individuals worldwide and >60,000 individuals in the United States alone (as of April 29, 2020).2 Of note, mortality estimates in some of the hardest hit regions have already or may need to be revised to account for a spike in sudden deaths occurring at home.Chloroquine-induced torsades de pointes in a patient with coronavirus disease 2019
The case for chloroquine and hydroxychloroquine, as treatment of the coronavirus disease 2019 (COVID-19) pandemic, has been voiced not only in medical journals1 but also in the popular press.2 Not only is the efficacy of these antimalarial and anti-inflammatory compounds as antiviral drugs uncertain, but there is also an ongoing debate about their safety.3 In particular, the magnitude of the proarrhythmic potential of these drugs, specifically related to their QT prolongation effects, is questioned: On the one hand, the fact that chloroquine and hydroxychloroquine block the rapid component of the delay rectifier potassium current (Ikr) potassium channel at the myocyte level, therefore causing QT prolongation, is well documented.EP News: Basic and Translational
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has been shown to be associated with a high inflammatory burden that can induce vascular inflammation, myocarditis, and cardiac arrhythmias. The current study by Hoffmann et al (Cell 2020;doi:10.1016/j.cell.2020.02.052; PMID 32142651) investigates the mechanisms of SARS-CoV-2 entry into mammalian cells. The spike (S) protein of coronaviruses facilitates viral entry into target cells by binding of the surface unit (S1) of the S protein to a cellular receptor, angiotensin-converting enzyme 2 (ACE2), as the entry receptor.EP News: Allied Professionals
In a departure from the usual format of review of 1 article followed by a discussion of 1 topic, given the unusual times, the discussion of 1 topic will predominate. There are already hundreds of articles with topics such as the cardiovascular manifestations of coronavirus disease (COVID-19), the increased risk to patients with preexisting cardiovascular disease, arrhythmias associated with infection, and proarrhythmic effects of proposed treatments to be found with a simple Google or PubMed search.EP News: Clinical
Lakkireddy et al (Heart Rhythm April 1, 2020; https://doi.org/10.1016/j.hrthm.2020.03.028 , PMID 32228309) summarized the available evidence and provided recommendations for electrophysiologists related to coronavirus 2019 (COVID-19) in a consensus document from the Heart Rhythm Society, American College of Cardiology, and American Heart Association. They noted that electrophysiologists, like all cardiologists and other health care workers, have been affected personally and professionally by this global catastrophe.EP News: Case Reports
The phenotype of Brugada syndrome is associated with a decrease in the sodium current and can manifest with sudden death in previously healthy individuals. Many triggers have been described, including fever, alcohol intake, and medications that cause sodium channel blockade. Coronavirus disease 2019 (COVID-19) most commonly presents with fever and a cough. Chang et al (doi: https://doi.org/10.1016/j.hrcr.2020.03.012 ) shared a case of a 49-year-old Bangladeshi man without a significant medical history who presented after an episode of syncope and fever.
