Figure 1
COVID-19 contributors to arrhythmogenesis. Created with BioRender.com.
AP: action potential; SIRS: systemic inflammatory response syndrome; QTc: corrected QT interval; hERGk: human ether-a-go-go related gene; APD: action potential duration; EAD: early afterdepolarization
Table 1
Arrhythmias in COVID-19. Incidence data based on available prospective and retrospective cohort data cited in text. AV: atrioventricular; AF/AFL: atrial fibrillation/atrial flutter; CCB: calcium channel blocker; BB: beta blocker; SVT: supraventricular tachycardia; AVN: atrioventricular node; PVCs: premature ventricular contractions; AADs: antiarrhythmic drugs; NSVT: nonsustained ventricular tachycardia; TdP: torsade de pointes; POTS: postural orthostatic tachycardia syndrome; ICD: implantable cardioverter defibrillator; IST: inappropriate sinus tachycardia
| TYPE | REPORTED INCIDENCE (%) | COMMENTS | MANAGEMENT STRATEGIES |
|---|---|---|---|
| Sinus tachycardia | 40-55% | Most common, appropriate in acute setting | COVID-19–directed treatment |
| Sinus bradycardia | 5-25% | Likely a poor prognostic marker |
|
| AF/AFL | 2-12% | Most common pathologic arrhythmia, poor prognostic marker |
|
| SVT | 0.6-6% | Usual care with adenosine, AVN blockers, and cardioversion if unstable | |
| PVCs | 0-28% | No evidence for prophylactic AADs | |
| NSVT | 0-15% | No evidence for prophylactic AADs | |
| Sustained VT/VF or TdP | 0-1.4% | Usually only in critical illness |
|
| AV block | 0-1.4% | Usually only in critical illness, unclear if reversible | Temporary or permanent pacing |
| POTS | 4-22% | Reported in the convalescent period due to dysautonomia |
|
| IST | 3-4% | Reported in the convalescent period due to dysautonomia | BBs, ivabradine |