Nabeh Omnia Azmy, Helaly Maiada Mohamed, Menshawey Rahma, Menshawey Esraa, Nasser Mohammed Mansoor Matooq, Diaa El-Deen Ahmed Mohamed
Department of Medical Pharmacology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.
Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.
Egypt Heart J. 2021 Aug 30;73(1):76. doi: 10.1186/s43044-021-00201-5.
Arrhythmia, one of the most common complications of COVID-19, was reported in nearly one-third of diagnosed COVID-19 patients, with higher prevalence rate among ICU admitted patients. The underlying etiology for arrhythmia in these cases are mostly multifactorial as those patients may suffer from one or more of the following predisposing mechanisms; catecholamine surge, hypoxia, myocarditis, cytokine storm, QTc prolongation, electrolyte disturbance, and pro-arrhythmic drugs usage. Obviously, the risk for arrhythmia and the associated lethal outcome would rise dramatically among patients with preexisting cardiac disease such as myocardial ischemia, heart failure, cardiomyopathy, and hereditary arrhythmias. Considering all of these variables, the management strategy of COVID-19 patients should expand from managing a viral infection and related host immune response to include the prevention of predictable causes for arrhythmia. This may necessitate the need to investigate the role of some drugs that modulate the pathway of arrhythmia generation. Of these drugs, we discuss the potential role of adrenergic antagonists, trimetazidine, ranolazine, and the debatable angiotensin converting enzyme inhibitors drugs. We also recommend monitoring the level of: unbound free fatty acids, serum electrolytes, troponin, and QTc (even in the absence of apparent pro-arrhythmic drug use) as these may be the only indicators for patients at risk for arrhythmic complications.
心律失常是新冠病毒肺炎最常见的并发症之一，近三分之一的新冠确诊患者报告有心律失常，在入住重症监护病房的患者中患病率更高。这些病例中心律失常的潜在病因大多是多因素的，因为这些患者可能存在以下一种或多种诱发机制：儿茶酚胺激增、缺氧、心肌炎、细胞因子风暴、QTc延长、电解质紊乱和使用促心律失常药物。显然，对于患有如心肌缺血、心力衰竭、心肌病和遗传性心律失常等基础心脏病的患者，心律失常风险及相关致命后果会显著增加。考虑到所有这些变量，新冠患者的管理策略应从管理病毒感染及相关宿主免疫反应扩展到包括预防可预测的心律失常病因。这可能需要研究一些调节心律失常发生途径的药物的作用。在这些药物中，我们讨论肾上腺素能拮抗剂、曲美他嗪、雷诺嗪以及有争议的血管紧张素转换酶抑制剂药物的潜在作用。我们还建议监测游离脂肪酸、血清电解质、肌钙蛋白和QTc水平（即使在未明显使用促心律失常药物的情况下），因为这些可能是有心律失常并发症风险患者的唯一指标。
