Atrial Arrhythmias in a Patient Presenting With Coronavirus Disease-2019 (COVID-19) Infection

Rajeev Seecheran, Roshni Narayansingh, Stanley Giddings, Marlon Rampaul, Kurt Furlonge, Kamille Abdool, Neal Bhagwandass, Naveen Anand Seecheran, Rajeev Seecheran, Roshni Narayansingh, Stanley Giddings, Marlon Rampaul, Kurt Furlonge, Kamille Abdool, Neal Bhagwandass, Naveen Anand Seecheran

Abstract

The coronavirus disease-2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) that has significant potential cardiovascular implications for patients. These include myocarditis, acute coronary syndromes, cardiac arrhythmias, cardiomyopathies with heart failure and cardiogenic shock, and venous thromboembolic events. We describe a Caribbean-Black gentleman with COVID-19 infection presenting with atrial arrhythmias, namely, atrial flutter and atrial fibrillation, which resolved with rate and rhythm control strategies, and supportive care.

Keywords: COVID-19; SARS-CoV-2; atrial arrhythmias; atrial fibrillation; atrial flutter; coronavirus disease 2019; severe acute respiratory syndrome coronavirus 2.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
The patient’s electrocardiogram in which the red arrows indicate the typical flutter waves (f-waves) that occur right before the QRS complex, simulating a pseudo-preexcitation pattern. The segment underscored in black indicates the f-waves in series at a rate of approximately 240 beats per minute. The QRS complexes are occurring at 120 to 140 beats per minute, hence the 2:1 atrioventricular block.
Figure 2.
Figure 2.
The patient’s chest radiograph does not indicate any airspace disease that would be expected in coronavirus-2019 (COVID-19) infection.
Figure 3.
Figure 3.
The patient’s rhythm strip post-cardioversion, which indicates coarse atrial fibrillation with a rapid ventricular response. The variable RR intervals highlighted by the interspersed red lines.

References

    1. Hui DS, Azhar EI, Madani TA, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health—the latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis. 2020;91:264-266.
    1. World Health Organization. Naming the coronavirus disease (COVID-19) and the virus that causes it. . Accessed March 24, 2020.
    1. World Health Organization. WHO Director-General’s opening remarks at the media briefing on COVID-19—11 March 2020. . Accessed March 24, 2020.
    1. World Health Organization. Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). . Accessed March 24, 2020.
    1. Li B, Yang J, Zhao F, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China [published online March 11, 2020]. Clin Res Cardiol. doi:10.1007/s00392-020-01626-9
    1. Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol. 2020;17:259-260. doi:10.1038/s41569-020-0360-5
    1. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054-1062. doi:10.1016/s0140-6736(20)30566-3
    1. Van Gelder IC, Hobbelt AH, Mulder BA, Rienstra M. Rate control in atrial fibrillation: many questions still unanswered. Circulation. 2015;132:1597-1599.
    1. Kelly JP, DeVore AD, Wu J, et al. Rhythm control versus rate control in patients with atrial fibrillation and heart failure with preserved ejection fraction: insights from get with the guidelines-heart failure. J Am Heart Assoc. 2019;8:e011560.
    1. Park HS, Kim YN. Adverse effects of long-term amiodarone therapy. Korean J Intern Med. 2014;29:571-573.
    1. Virgadamo S, Charnigo R, Darrat Y, Morales G, Elayi CS. Digoxin: a systematic review in atrial fibrillation, congestive heart failure and post myocardial infarction. World J Cardiol. 2015;7:808-816.
    1. Gautret P, Lagier JC, Parola P, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial [published online March 20, 2020]. Int J Antimicrob Agents. doi:10.1016/j.ijantimicag.2020.105949
    1. Ray WA, Murray KT, Hall K, Arbogast PG, Stein CM. Azithromycin and the risk of cardiovascular death. N Engl J Med. 2012;366:1881-1890.
    1. Cao B, Wang Y, Wen D, et al. A Trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19 [published online March 18, 2020]. N Engl J Med. doi:10.1056/NEJMoa2001282
    1. Shi S, Qin M, Shen B, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China [published online March 25, 2020]. JAMA Cardiol. doi:10.1001/jamacardio.2020.0950
    1. Liu K, Fang YY, Deng Y, et al. Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province [published online February 7, 2020]. Chin Med J. doi:10.1097/CM9.0000000000000744
    1. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China [published online February 7, 2020]. JAMA. doi:10.1001/jama.2020.1585
    1. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study [published online February 24, 2020]. Lancet Respir Med. doi:10.1016/s2213-2600(20)30079-5
    1. Chen C, Zhou Y, Wang DW. SARS-CoV-2: a potential novel etiology of fulminant myocarditis [published online March 5, 2020]. Herz. doi:10.1007/s00059-020-04909-z
    1. The Surviving Sepsis Campaign: guidelines on the management of critically ill adults with COVID-19 . Accessed March 25, 2020.
    1. Li R, Wang Y, Ma Z, et al. Maresin 1 mitigates inflammatory response and protects mice from sepsis. Mediators Inflamm. 2016;2016:3798465.
    1. Kuipers S, Klouwenberg PMK, Cremer OL. Incidence, risk factors and outcomes of new-onset atrial fibrillation in patients with sepsis: a systematic review. Crit Care. 2014;18:688.
    1. Goodman S, Weiss Y, Weissman C. Update on cardiac arrhythmias in the ICU. Curr Opin Crit Care. 2008;14:549-554.
    1. Aviles RJ, Martin DO, Apperson-Hansen C, et al. Inflammation as a risk factor for atrial fibrillation. Circulation 2003;108:3006-3010.
    1. Seguin P, Launey Y. Atrial fibrillation is not just an artefact in the ICU. Crit Care. 2010;14:182.
    1. Walkey AJ, Wiener RS, Ghobrial JM, Curtis LH, Benjamin EJ. Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis. JAMA. 2011;306:2248-2254.
    1. Okajima M, Takamura M, Taniguchi T. Landiolol, an ultra-short-acting β1-blocker, is useful for managing supraventricular tachyarrhythmias in sepsis. World J Crit Care Med. 2015;4:251-257.
    1. Darwish OS, Strube S, Nguyen HM, Tanios MA. Challenges of anticoagulation for atrial fibrillation in patients with severe sepsis. Ann Pharmacother. 2013;47:1266-1271.
    1. Otake H, Suzuki H, Honda T, Maruyama Y. Influences of autonomic nervous system on atrial arrhythmogenic substrates and the incidence of atrial fibrillation in diabetic heart. Int Heart J. 2009;50:627-641.
    1. Leibovici L, Gafter-Gvili A, Paul M, et al. Relative tachycardia in patients with sepsis: an independent risk factor for mortality. QJM. 2007;100:629-634.
    1. Bers DM. Cardiac excitation-contraction coupling. Nature. 2002;415:198-205.
    1. Keurs HET, Boyden PA. Calcium and arrhythmogenesis. Physiol Rev. 2007;87:457-506.
    1. Zou L, Feng Y, Chen YJ, et al. Toll-like receptor 2 plays a critical role in cardiac dysfunction during polymicrobial sepsis. Crit Care Med. 2010;38:1335-1342.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera