Peculiar aspects of patients with inherited arrhythmias during the COVID-19 pandemic

Abstract

Since December 2019 we have observed the rapid advance of the severe acute respiratory syndrome caused by the new coronavirus (SARS-CoV-2). The impact of the clinical course of a respiratory infection is little known in patients with hereditary arrhythmias, due to the low prevalence of these diseases. Patients who present with infectious conditions may exacerbate hidden or well-controlled primary arrhythmias, due to several factors, such as fever, electrolyte disturbances, drug interactions, adrenergic stress and, eventually, the septic patient’s own myocardial damage. The aim of this review is to highlight the main challenges we may encounter during the Covid 19 pandemic, specifically in patients with hereditary arrhythmias, with emphasis on the congenital long QT syndrome (LQTS), Brugada syndrome (SBr), ventricular tachycardia polymorphic catecholaminergic (CPVT) and arrhythmogenic right ventricular cardiomyopathy. Since December 2019 we have observed the rapid advance of the severe acute respiratory syndrome caused by the new coronavirus (SARS-CoV-2), the first cases of which arose in Wuhan, China, subsequently arriving in Brazil. Retrospective studies have shown that old age was an independent predictor of mortality by COVID-19. Other risk factors impacting mortality were systemic arterial hypertension, chronic pulmonary obstructive disease, immunosuppression, type-2 diabetes mellitus, obesity, and severe cardiopathy (heart failure, coronary disease, or cardiomyopathies).1,2 Overall, complications due to arrhythmias in patients with pneumonia, particularly atrial fibrillation, are relatively common.3,4 Cardiac arrest occurs in about 3% of hospitalized patients;5 however, less than 20% of cardiac rhythms of in-hospital events are reported as being electrically reversible to sinus rhythm (by cardioversion or defibrillation), i.e., ventricular tachycardia/fibrillation (VT/VF).6 In such patients, the primary arrhythmogenic mechanism is myocardial injury due to ischemia or inflammation.4.