Subscribe to RSS
DOI: 10.1055/a-1764-5085
COVID-19-assoziierte Herzrhythmusstörungen
Ein schwerer Krankheitsverlauf im Rahmen einer COVID-19-Infektion kann mit bradykarden und tachykarden Herzrhythmusstörungen einhergehen. Die Pathomechanismen für die Manifestation der Herzrhythmusstörungen sind dementsprechend vielfaltig und teilweise nicht ganz verstanden. Folgend werden COVID-19-assoziierte Herzrhythmusstörungen mit Bezug auf ihre Epidemiologie, mögliche Pathomechanismen und ihr Management beschrieben.
-
Sowohl bradykarde als auch tachykarde Herzrhythmusstörungen können mit einer COVID-19-Infektion assoziiert sein. Am häufigsten tritt Vorhofflimmern auf.
-
Die Pathomechanismen für die Entstehung von Herzrhythmusstörungen scheinen nicht virusspezifisch zu sein, sondern Folge der Erkrankung und der eingeleiteten Therapiemaßnahmen.
-
Herzrhythmusstörungen im Rahmen von COVID-19-Infektionen treten gehäuft bei schweren Krankheitsverläufen auf und sind mit einer ungünstigen Prognose vergesellschaftet.
-
Das kurzfristige Therapiemanagement unterscheidet sich nicht von der üblichen Behandlung und richtet sich nach den Leitlinienempfehlungen.
-
Eine Reevaluation des Rhythmusmanagements wird nach ausgeheilter COVID-19-Infektion empfohlen.
Schlüsselwörter
COVID-19 - Herzrhythmusstörung - Arrhythmie - Pathomechanismen - Tachykardie-SyndromPublication History
Article published online:
06 December 2022
© 2022. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
Literatur
- 1 Robert Koch-Institut. RKI – Coronavirus SARS-CoV-2 – COVID-19: Fallzahlen in Deutschland und weltweit. Accessed September 11, 2022 at: https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Fallzahlen.html%20Stand%2004/2022
- 2 World Health Organization. WHO Coronavirus (COVID-19) Dashboard. Accessed September 11, 2022 at: https://covid19.who.int
- 3 Li H, Burm SW, Hong SH. et al. A Comprehensive Review of Coronavirus Disease 2019: Epidemiology, Transmission, Risk Factors, and International Responses. Yonsei Med J 2021; 62: 1-11 DOI: 10.3349/ymj.2021.62.1.1.
- 4 Lai CC, Liu YH, Wang CY. et al. Asymptomatic carrier state, acute respiratory disease, and pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): Facts and myths. J Microbiol Immunol Infect 2020; 53: 404-412 DOI: 10.1016/j.jmii.2020.02.012.
- 5 Lai CC, Ko WC, Lee PI. et al. Extra-respiratory manifestations of COVID-19. Int J Antimicrob Agents 2020; 56: 106024 DOI: 10.1016/j.ijantimicag.2020.106024.
- 6 Shi S, Qin M, Shen B. et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol 2020; 5: 802 DOI: 10.1001/jamacardio.2020.0950.
- 7 Peltzer B, Manocha KK, Ying X. et al. Arrhythmic Complications of Patients Hospitalized With COVID-19: Incidence, Risk Factors, and Outcomes. Circ Arrhythm Electrophysiol 2020; 13: e009121 DOI: 10.1161/CIRCEP.120.009121.
- 8 Turagam MK, Musikantow D, Goldman ME. et al. Malignant Arrhythmias in Patients With COVID-19: Incidence, Mechanisms, and Outcomes. Circ Arrhythm Electrophysiol 2020; 13: e008920 DOI: 10.1161/CIRCEP.120.008920.
- 9 Task Force for the management of COVID-19 of the European Society of Cardiology. ESC guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 2-care pathways, treatment, and follow-up. Cardiovasc Res 2022; 118: 1618-1666 DOI: 10.1093/cvr/cvab343.
- 10 Kochav SM, Coromilas E, Nalbandian A. et al. Cardiac Arrhythmias in COVID-19 Infection. Circ Arrhythm Electrophysiol 2020; 13: e008719 DOI: 10.1161/CIRCEP.120.008719.
- 11 Wang D, Hu B, Hu C. et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020; 323: 1061-1069 DOI: 10.1001/jama.2020.1585.
- 12 Gopinathannair R, Merchant FM, Lakkireddy DR. et al. COVID-19 and cardiac arrhythmias: a global perspective on arrhythmia characteristics and management strategies. J Interv Card Electrophysiol 2020; 59: 329-336 DOI: 10.1007/s10840-020-00789-9.
- 13 Boriani G, Fauchier L, Aguinaga L. et al. European Heart Rhythm Association (EHRA) consensus document on management of arrhythmias and cardiac electronic devices in the critically ill and post-surgery patient, endorsed by Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Cardiac Arrhythmia Society of Southern Africa (CASSA), and Latin American Heart Rhythm Society (LAHRS). Europace 2019; 21: 7-8 DOI: 10.1093/europace/euy110.
- 14 Al-Assaf O, Mirza M, Musa A. Atypical presentation of COVID-19 as subclinical myocarditis with persistent high-degree atrioventricular block treated with pacemaker implant. HeartRhythm Case Rep 2020; 6: 884-887 DOI: 10.1016/j.hrcr.2020.09.003.
- 15 Goyal P, Choi JJ, Pinheiro LC. et al. Clinical Characteristics of Covid-19 in New York City. N Engl J Med 2020; 382: 2372-2374 DOI: 10.1056/NEJMc2010419.
- 16 Colon CM, Barrios JG, Chiles JW. et al. Atrial Arrhythmias in COVID-19 Patients. JACC Clin Electrophysiol 2020; 6: 1189-1190 DOI: 10.1016/j.jacep.2020.05.015.
- 17 Peltzer B, Manocha KK, Ying X. et al. Outcomes and mortality associated with atrial arrhythmias among patients hospitalized with COVID-19. J Cardiovasc Electrophysiol 2020; 31: 3077-3085 DOI: 10.1111/jce.14770.
- 18 Szarpak L, Filipiak KJ, Skwarek A. et al. Outcomes and mortality associated with atrial arrhythmias among patients hospitalized with COVID-19: A systematic review and meta-analysis. Cardiol J 2022; 29: 33-43 DOI: 10.5603/CJ.a2021.0167.
- 19 Xie Y, Xu E, Bowe B. et al. Long-term cardiovascular outcomes of COVID-19. Nat Med 2022; 28: 583-590 DOI: 10.1038/s41591-022-01689-3.
- 20 Guo T, Fan Y, Chen M. et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol 2020; 5: 811 DOI: 10.1001/jamacardio.2020.1017.
- 21 Baldi E, Sechi GM, Mare C. et al. Out-of-Hospital Cardiac Arrest during the Covid-19 Outbreak in Italy. N Engl J Med 2020; 383: 496-498 DOI: 10.1056/NEJMc2010418.
- 22 Lim ZJ, Ponnapa Reddy M, Afroz A. et al. Incidence and outcome of out-of-hospital cardiac arrests in the COVID-19 era: A systematic review and meta-analysis. Resuscitation 2020; 157: 248-258 DOI: 10.1016/j.resuscitation.2020.10.025.
- 23 Nalbandian A, Sehgal K, Gupta A. et al. Post-acute COVID-19 syndrome. Nat Med 2021; 27: 601-615 DOI: 10.1038/s41591-021-01283-z.
- 24 Ståhlberg M, Reistam U, Fedorowski A. et al. Post-COVID-19 Tachycardia Syndrome: A Distinct Phenotype of Post-Acute COVID-19 Syndrome. Am J Med 2021; 134: 1451-1456 DOI: 10.1016/j.amjmed.2021.07.004.
- 25 Kochi AN, Tagliari AP, Forleo GB. et al. Cardiac and arrhythmic complications in patients with COVID-19. J Cardiovasc Electrophysiol 2020; 31: 1003-1008 DOI: 10.1111/jce.14479.
- 26 Babapoor-Farrokhran S, Gill D, Walker J. et al. Myocardial injury and COVID-19: Possible mechanisms. Life Sci 2020; 253: 117723 DOI: 10.1016/j.lfs.2020.117723.
- 27 Lazzerini PE, Boutjdir M, Capecchi PL. COVID-19, Arrhythmic Risk, and Inflammation: Mind the Gap!. Circulation 2020; 142: 7-9 DOI: 10.1161/CIRCULATIONAHA.120.047293.
- 28 Siripanthong B, Nazarian S, Muser D. et al. Recognizing COVID-19-related myocarditis: The possible pathophysiology and proposed guideline for diagnosis and management. Heart Rhythm 2020; 17: 1463-1471 DOI: 10.1016/j.hrthm.2020.05.001.
- 29 Peretto G, Sala S, Rizzo S. et al. Arrhythmias in myocarditis: State of the art. Heart Rhythm 2019; 16: 793-801 DOI: 10.1016/j.hrthm.2018.11.024.
- 30 Wrapp D, Wang N, Corbett KS. et al. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science 2020; 367: 1260-1263 DOI: 10.1126/science.abb2507.
- 31 Vaduganathan M, Vardeny O, Michel T. et al. Renin-Angiotensin-Aldosterone System Inhibitors in Patients with Covid-19. N Engl J Med 2020; 382: 1653-1659 DOI: 10.1056/NEJMsr2005760.
- 32 Aimo A, Baritussio A, Emdin M. et al. Amiodarone as a possible therapy for coronavirus infection. Eur J Prev Cardiol 2021; 28: e16-e18 DOI: 10.1177/2047487320919233.
- 33 Tse G, Yeo JM, Chan YW. et al. What Is the Arrhythmic Substrate in Viral Myocarditis? Insights from Clinical and Animal Studies. Front Physiol 2016; 7: 308 DOI: 10.3389/fphys.2016.00308.
- 34 Lazzerini PE, Capecchi PL, Laghi-Pasini F. Long QT Syndrome: An Emerging Role for Inflammation and Immunity. Front Cardiovasc Med 2015; 2: 26 DOI: 10.3389/fcvm.2015.00026.
- 35 Lazzerini PE, Laghi-Pasini F, Boutjdir M. et al. Cardioimmunology of arrhythmias: the role of autoimmune and inflammatory cardiac channelopathies. Nat Rev Immunol 2019; 19: 63-64 DOI: 10.1038/s41577-018-0098-z.
- 36 Lazzerini PE, Acampa M, Capecchi PL. et al. Antiarrhythmic potential of anticytokine therapy in rheumatoid arthritis: tocilizumab reduces corrected QT interval by controlling systemic inflammation. Arthritis Care Res (Hoboken) 2015; 67: 332-339 DOI: 10.1002/acr.22455.
- 37 Tang N, Li D, Wang X. et al. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020; 18: 844-847 DOI: 10.1111/jth.14768.
- 38 Hunt BJ. Bleeding and Coagulopathies in Critical Care. N Engl J Med 2014; 370: 847-859 DOI: 10.1056/NEJMra1208626.
- 39 Huertas A, Montani D, Savale L. et al. Endothelial cell dysfunction: a major player in SARS-CoV-2 infection (COVID-19)?. Eur Respir J 2020; 56: 2001634 DOI: 10.1183/13993003.01634-2020.
- 40 Varga Z, Flammer AJ, Steiger P. et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet 2020; 395: 1417-1418 DOI: 10.1016/S0140-6736(20)30937-5.
- 41 Bangalore S, Sharma A, Slotwiner A. et al. ST-Segment Elevation in Patients with Covid-19 – A Case Series. N Engl J Med 2020; 382: 2478-2480 DOI: 10.1056/NEJMc2009020.
- 42 Musher DM, Abers MS, Corrales-Medina VF. Acute Infection and Myocardial Infarction. N Engl J Med 2019; 380: 171-176 DOI: 10.1056/NEJMra1808137.
- 43 Klok FA, Kruip MJHA, van der Meer NJM. et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020; 191: 145-147 DOI: 10.1016/j.thromres.2020.04.013.
- 44 Ñamendys-Silva SA, Santos-Martínez LE, Pulido T. et al. Pulmonary hypertension due to acute respiratory distress syndrome. Braz J Med Biol Res 2014; 47: 904-910 DOI: 10.1590/1414-431×20143316.
- 45 Wanamaker B, Cascino T, McLaughlin V. et al. Atrial Arrhythmias in Pulmonary Hypertension: Pathogenesis, Prognosis and Management. Arrhythm Electrophysiol Rev 2018; 7: 43-48 DOI: 10.15420/aer.2018.3.2.
- 46 Alreshq R, Hsu G, Torosoff M. Acute Pulmonary Embolism Presenting with Symptomatic Bradycardia: A Case Report and Review of the Literature. Am J Case Rep 2019; 20: 748-752 DOI: 10.12659/AJCR.915609.
- 47 Surawicz B. Role of electrolytes in etiology and management of cardiac arrhythmias. Prog Cardiovasc Dis 1966; 8: 364-386 DOI: 10.1016/s0033-0620(66)80011-7.
- 48 Lippi G, South AM, Henry BM. Electrolyte imbalances in patients with severe coronavirus disease 2019 (COVID-19). Ann Clin Biochem 2020; 57: 262-265 DOI: 10.1177/0004563220922255.
- 49 Gabarre P, Dumas G, Dupont T. et al. Acute kidney injury in critically ill patients with COVID-19. Intensive Care Med 2020; 46: 1339-1348 DOI: 10.1007/s00134-020-06153-9.
- 50 Gaber Y. Diarrhoea and the COVID-19 pandemic. Arab J Gastroenterol 2020; 21: 146-150 DOI: 10.1016/j.ajg.2020.06.001.
- 51 Bosch NA, Cimini J, Walkey AJ. Atrial Fibrillation in the ICU. Chest 2018; 154: 1424-1434 DOI: 10.1016/j.chest.2018.03.040.
- 52 Giudicessi JR, Noseworthy PA, Friedman PA. et al. Urgent Guidance for Navigating and Circumventing the QTc-Prolonging and Torsadogenic Potential of Possible Pharmacotherapies for Coronavirus Disease 19 (COVID-19). Mayo Clin Proc 2020; 95: 1213-1221 DOI: 10.1016/j.mayocp.2020.03.024.
- 53 Erickson TB, Chai PR, Boyer EW. Chloroquine, hydroxychloroquine and COVID-19. Toxicol Commun 2020; 4: 40-42 DOI: 10.1080/24734306.2020.1757967.
- 54 Nabati M, Parsaee H. Potential Cardiotoxic Effects of Remdesivir on Cardiovascular System: A Literature Review. Cardiovasc Toxicol 2022; 22: 268-272 DOI: 10.1007/s12012-021-09703-9.
- 55 Sakabe M, Yoshioka R, Fujiki A. Sick sinus syndrome induced by interferon and ribavirin therapy in a patient with chronic hepatitis C. J Cardiol Cases 2013; 8: 173-175 DOI: 10.1016/j.jccase.2013.08.002.
- 56 Dherange P, Lang J, Qian P. et al. Arrhythmias and COVID-19: A Review. JACC Clin Electrophysiol 2020; 6: 1193-1204 DOI: 10.1016/j.jacep.2020.08.002.