Gopinathannair Rakesh, Merchant Faisal M, Lakkireddy Dhanunjaya R, Etheridge Susan P, Feigofsky Suzy, Han Janet K, Kabra Rajesh, Natale Andrea, Poe Stacy, Saha Sandeep A, Russo Andrea M
The Kansas City Heart Rhythm Institute & Research Foundation, 5100 W 110th St, Ste 200, Overland Park, KS, 66211, USA.
University of Missouri-Columbia, Columbia, USA.
J Interv Card Electrophysiol. 2020 Nov;59(2):329-336. doi: 10.1007/s10840-020-00789-9. Epub 2020 Jun 3.
Cardiovascular and arrhythmic events have been reported in hospitalized COVID-19 patients. However, arrhythmia manifestations and treatment strategies used in these patients have not been well-described. We sought to better understand the cardiac arrhythmic manifestations and treatment strategies in hospitalized COVID-19 patients through a worldwide cross-sectional survey.
The Heart Rhythm Society (HRS) sent an online survey (via SurveyMonkey) to electrophysiology (EP) professionals (physicians, scientists, and allied professionals) across the globe. The survey was active from March 27 to April 13, 2020.
A total of 1197 respondents completed the survey with 50% of respondents from outside the USA, representing 76 countries and 6 continents. Of respondents, 905 (76%) reported having COVID-19-positive patients in their hospital. Atrial fibrillation was the most commonly reported tachyarrhythmia whereas severe sinus bradycardia and complete heart block were the most common bradyarrhythmias. Ventricular tachycardia/ventricular fibrillation arrest and pulseless electrical activity were reported by 4.8% and 5.6% of respondents, respectively. There were 140 of 631 (22.2%) respondents who reported using anticoagulation therapy in all COVID-19-positive patients who did not otherwise have an indication. One hundred fifty-five of 498 (31%) reported regular use of hydroxychloroquine/chloroquine (HCQ) + azithromycin (AZM); concomitant use of AZM was more common in the USA. Sixty of 489 respondents (12.3%) reported having to discontinue therapy with HCQ + AZM due to significant QTc prolongation and 20 (4.1%) reported cases of Torsade de Pointes in patients on HCQ/chloroquine and AZM. Amiodarone was the most common antiarrhythmic drug used for ventricular arrhythmia management.
In this global survey of > 1100 EP professionals regarding hospitalized COVID-19 patients, a variety of arrhythmic manifestations were observed, ranging from benign to potentially life-threatening. Observed adverse events related to use of HCQ + AZM included prolonged QTc requiring drug discontinuation as well as Torsade de Pointes. Large prospective studies to better define arrhythmic manifestations as well as the safety of treatment strategies in COVID-19 patients are warranted.
住院的COVID-19患者中曾有心血管和心律失常事件的报道。然而，这些患者的心律失常表现及所采用的治疗策略尚未得到充分描述。我们试图通过一项全球横断面调查，更好地了解住院COVID-19患者的心律失常表现及治疗策略。
心律协会（HRS）通过SurveyMonkey向全球的电生理（EP）专业人员（医生、科学家及相关专业人员）发送了一份在线调查问卷。该调查于2020年3月27日至4月13日进行。
共有1197名受访者完成了调查，其中50%的受访者来自美国以外地区，代表76个国家和6个大洲。在受访者中，905人（76%）报告其所在医院有COVID-19阳性患者。心房颤动是最常报告的快速性心律失常，而严重窦性心动过缓和完全性心脏传导阻滞是最常见的缓慢性心律失常。分别有4.8%和5.6%的受访者报告了室性心动过速/心室颤动骤停和无脉性电活动。在631名受访者中有140人（22.2%）报告在所有无其他抗凝指征的COVID-19阳性患者中使用了抗凝治疗。在498名受访者中有155人（31%）报告常规使用羟氯喹/氯喹（HCQ）+阿奇霉素（AZM）；在美国，同时使用AZM更为常见。489名受访者中有60人（12.3%）报告因显著的QTc延长而不得不停用HCQ+AZM治疗，20人（4.1%）报告了服用HCQ/氯喹和AZM的患者发生尖端扭转型室速的病例。胺碘酮是用于治疗室性心律失常最常用的抗心律失常药物。
在这项针对1100多名关于住院COVID-19患者的EP专业人员的全球调查中，观察到了从良性到潜在危及生命的各种心律失常表现。观察到的与使用HCQ+AZM相关的不良事件包括因QTc延长而需要停药以及尖端扭转型室速。有必要开展大型前瞻性研究，以更好地明确COVID-19患者的心律失常表现以及治疗策略的安全性。
