Blasi Federico, Vicenzi Marco, De Ponti Roberto
Department of Science and High Technology, University of Insubria, 21100 Varese, Italy.
Cardiology Unit, Department of Internal Medicine, Ospedale di Circolo, ASST-Rhodense, 20017 Rho, Italy.
J Clin Med. 2024 Nov 29;13(23):7259. doi: 10.3390/jcm13237259.
Over the last few years, COVID-19 has attracted medical attention both in terms of healthcare system reorganization and research. Among the different cardiovascular complications of the SARS-CoV-2 infection, cardiac arrhythmias represent an important clinical manifestation requiring proper therapy both in the acute and post-acute phase. The multiparametric in-hospital monitoring of COVID-19 patients frequently detects new-onset or recurrent cardiac arrhythmias. As many patients are monitored remotely from cardiology departments, this setting calls for proper arrhythmia interpretation and management, especially in critically ill patients in the intensive care unit. From this perspective, the possible pathophysiologic mechanisms and the main clinical manifestations of brady- and tachyarrhythmias in COVID-19 patients are briefly presented. The progressively increasing body of evidence on pathophysiology helps to identify the reversible causes of arrhythmias, better clarify the setting in which they occur, and establish their impact on prognosis, which are of paramount importance to orient decision making. Despite the accumulating knowledge on this disease, some dilemmas in the management of these patients may remain, such as the need to implant in the acute or post-acute phase a permanent pacemaker or cardioverter/defibrillation in patients presenting with brady- or tachyarrhythmias and lifelong oral anticoagulation in new-onset atrial fibrillation detected during SARS-CoV-2 infection.
在过去几年中，新冠病毒病（COVID-19）在医疗系统重组和研究方面都引起了医学关注。在严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染的不同心血管并发症中，心律失常是一种重要的临床表现，在急性期和急性后期都需要适当治疗。对COVID-19患者进行的多参数院内监测经常能检测到新发或复发性心律失常。由于许多患者是由心脏病科进行远程监测的，这种情况需要对心律失常进行正确的解读和管理，尤其是对重症监护病房中的危重症患者。从这个角度出发，本文简要介绍了COVID-19患者缓慢性和快速性心律失常可能的病理生理机制及主要临床表现。关于病理生理学的证据越来越多，这有助于确定心律失常的可逆原因，更好地阐明其发生的背景，并确定其对预后的影响，这对指导决策至关重要。尽管对这种疾病的认识不断积累，但在这些患者的管理中仍可能存在一些困境，例如在急性期或急性后期，对于出现缓慢性或快速性心律失常的患者，是否需要植入永久性起搏器或心脏复律除颤器，以及对于在SARS-CoV-2感染期间检测到的新发房颤患者，是否需要终身口服抗凝药。
