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Dumargne H, Patural H, Charbonnieras F, Charier D, Biscarrat C, Chivot M, Argaud L, Cour M, Dargent A. Exploration of COVID-19 associated bradycardia using heart rate variability analysis in a case-control study of ARDS patients. Heart Lung 2024; 68:74-80. [PMID: 38941770 DOI: 10.1016/j.hrtlng.2024.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/19/2024] [Accepted: 06/21/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Bradycardia and dysautonomia observed during SARS-Cov2 infection suggests involvement of the autonomic nervous system (ANS). Limited data exists on ANS dysregulation and its association with outcomes in patients with acute respiratory distress syndrome (ARDS) related to COVID-19 (C-ARDS) or other etiologies (NC-ARDS). OBJECTIVES We aimed to explore sympathovagal balance, assessed by heart rate variability (HRV), and its clinical prognostic value in C-ARDS compared with NC-ARDS. METHODS A single-center, prospective case-control study was conducted. Consecutive patients meeting ARDS criteria between 2020 and 2022 were included. HRV was assessed using 1-hour electrographic tracing during a stable, daytime period. RESULTS Twenty-four patients with C-ARDS and 19 with NC-ARDS were included. Age, sex and ARDS severity were similar between groups. The median heart rate was markedly lower in the C-ARDS group than in the NC-ARDS group (60 [53-72] versus 101 [91-112] bpm, p<.001). Most of HRV parameters were significantly increased in patients with C-ARDS. HRV correlated with heart rate only in patients with C-ARDS. A positive correlation was found between the low-to high-frequency ratio (LF/HF) and length of intensive care unit stay (r = 0.576, p<.001). CONCLUSION This study confirmed that C-ARDS was associated with marked bradycardia and severe ANS impairment, suggesting a sympathovagal imbalance with vagal overtone. Poor outcomes appeared to be more related to sympathetic rather than parasympathetic hyperactivation.
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Affiliation(s)
- Hugo Dumargne
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, 69003 Lyon, France
| | - Hugues Patural
- Centre Hospitalier Universitaire de Saint Etienne, Service de réanimation pédiatrique, Saint-Etienne, France; INSERM, SAINBIOSE U1059, 42055 Saint-Etienne, France
| | - François Charbonnieras
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service de Cardiologie soins intensifs, 69004 Lyon, France
| | - David Charier
- INSERM, SAINBIOSE U1059, 42055 Saint-Etienne, France; Centre Hospitalier Universitaire de Saint Etienne, Service d'Anesthésie-Réanimation, Saint-Etienne, France
| | - Charlotte Biscarrat
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, 69003 Lyon, France
| | - Matthieu Chivot
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, 69003 Lyon, France
| | - Laurent Argaud
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, 69003 Lyon, France
| | - Martin Cour
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, 69003 Lyon, France
| | - Auguste Dargent
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'Anesthésie-Réanimation Médecine Intensive-Réanimation, 69495 Pierre-Bénite, Lyon, France; APCSe VetAgro Sup UPSP 2016.A101, 69280 Marcy l'Etoile, France.
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Ogiwara M, Ihara H, Muto Y, Haba M, Nakazawa H, Hotta S, Jo H, Hayama N, Honma Y, Hoshi S, Fujii M, Takahashi K. The inciting factor for bradycardia in COVID-19 patients: a potential harm of steroid treatment. J Thorac Dis 2024; 16:2835-2844. [PMID: 38883622 PMCID: PMC11170389 DOI: 10.21037/jtd-23-1382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 03/15/2024] [Indexed: 06/18/2024]
Abstract
Background The coronavirus disease 2019 (COVID-19) is a condition caused by the novel severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). Although several papers have reported the presence bradycardia in patients with COVID-19, the pathophysiology behind this remains unclear. Therefore, we investigated the presence of bradycardia in patients with COVID-19. Methods We conducted a retrospective cohort study in a total of 153 patients with COVID-19 and 90 patients with influenza who were hospitalized in our hospital from January 1, 2020 to December 31, 2021 and from January 1, 2014 to December 31, 2021, respectively. Data were collected from patient medical records, which included sex, age, duration of hospitalization, pneumonia complications, supplemental oxygen therapy, antiviral treatment, past history, and vital signs. Results After adjustment, the incidence of bradycardia and steroid use in patients with COVID-19 were significantly higher than those in patients with influenza (P=0.007 and P<0.001, respectively). We then compared the detailed characteristics of patients with COVID-19 to evaluate risk factors for bradycardia. Multivariate logistic regression analysis revealed that steroid use was significantly related to bradycardia [P=0.031; odds ratio (OR): 3.67; 95% confidence interval (CI): 1.12-11.96]. Overall, results showed a higher incidence of bradycardia in patients with COVID-19 who received steroid treatment. Conclusions Our results showed that steroid treatment in patients with COVID-19 may be associated with the incidence of bradycardia.
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Affiliation(s)
- Misa Ogiwara
- Department of Respiratory Medicine, Juntendo University, Faculty of Medicine & Graduate School of Medicine, Tokyo, Japan
| | - Hiroaki Ihara
- Department of Respiratory Medicine, Juntendo University, Faculty of Medicine & Graduate School of Medicine, Tokyo, Japan
- Department of Respiratory Medicine, Koto Hospital, Tokyo, Japan
| | - Yuki Muto
- Department of Respiratory Medicine, Juntendo University, Faculty of Medicine & Graduate School of Medicine, Tokyo, Japan
| | - Manami Haba
- Department of Respiratory Medicine, Juntendo University, Faculty of Medicine & Graduate School of Medicine, Tokyo, Japan
| | - Hiroki Nakazawa
- Department of Respiratory Medicine, Juntendo University, Faculty of Medicine & Graduate School of Medicine, Tokyo, Japan
- Department of Respiratory Medicine, Koto Hospital, Tokyo, Japan
| | - Saori Hotta
- Department of Respiratory Medicine, Juntendo University, Faculty of Medicine & Graduate School of Medicine, Tokyo, Japan
| | - Hitomi Jo
- Department of Respiratory Medicine, Juntendo University, Faculty of Medicine & Graduate School of Medicine, Tokyo, Japan
- Department of Respiratory Medicine, Koto Hospital, Tokyo, Japan
| | - Noriko Hayama
- Department of Respiratory Medicine, Koto Hospital, Tokyo, Japan
| | - Yuichiro Honma
- Department of Respiratory Medicine, Juntendo University, Faculty of Medicine & Graduate School of Medicine, Tokyo, Japan
- Department of Respiratory Medicine, Koto Hospital, Tokyo, Japan
| | - Sakuo Hoshi
- Department of Respiratory Medicine, Koto Hospital, Tokyo, Japan
| | - Mitsuhiro Fujii
- Department of Respiratory Medicine, Juntendo University, Faculty of Medicine & Graduate School of Medicine, Tokyo, Japan
- Department of Respiratory Medicine, Koto Hospital, Tokyo, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University, Faculty of Medicine & Graduate School of Medicine, Tokyo, Japan
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Johal A, Udongwo N, Imburgio S, Mararenko A, Akhlaq H, Dandu S, Abe T, Almendral J, Heaton J, Hansalia R. Negative effects of COVID-19 on the implantation rate of cardiac resynchronization therapy with defibrillator device. J Arrhythm 2024; 40:237-246. [PMID: 38586844 PMCID: PMC10995599 DOI: 10.1002/joa3.12994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/29/2023] [Accepted: 01/06/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction COVID-19 drastically impacted the landscape of the United States' medical system. Limited data is available on the nationwide implantation trends in Cardiac Resynchronization Therapy Defibrillator (CRT-D) devices before and during the pandemic. We aimed to explore the impact of the COVID-19 pandemic on CRT-D insertion rates and adverse outcomes related to delays in care. Methods and Results We conducted a retrospective cross-sectional analysis using the National Inpatient Sample database between 2017 and 2020. Variables were identified using their ICD-10 codes. Inclusion criteria: age ≥ 18 years, presenting for a nonelective admission, primary diagnosis of hypertensive heart disease, hypertensive heart, chronic kidney disease, or heart failure, and underwent insertion of a CRT-D. Between 2017 and 2020, CRT-D devices were inserted during 23,635 admissions. On average, 6198 devices were implanted yearly from 2017 to 2019, with only 5040 devices being implanted in 2020. Additionally, reduced implantation rates were noted for every cohort of hospital size, location, and teaching status during this year. The year 2020 also had the highest average death rate at 1.39%, but this difference was statistically insignificant (adjusted Wald test p = .767), and COVID-19 was not associated with an increased risk of inpatient mortality (OR 0.22, 95% CI 0.03-1.82, p = .162). Conclusion The COVID-19 pandemic has affected all facets of the healthcare system, especially surgical volume rates. CRT-D procedures significantly decreased in 2020. This is the first retrospective study highlighting the trend of reduced rates of CRT-D implantation as a response to the COVID-19 pandemic.
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Affiliation(s)
- Anmol Johal
- Department of MedicineJersey Shore University Medical CenterNeptune CityNew JerseyUSA
| | - Ndausung Udongwo
- Department of MedicineJersey Shore University Medical CenterNeptune CityNew JerseyUSA
| | - Steven Imburgio
- Department of MedicineJersey Shore University Medical CenterNeptune CityNew JerseyUSA
| | - Anton Mararenko
- Department of MedicineJersey Shore University Medical CenterNeptune CityNew JerseyUSA
| | - Hira Akhlaq
- Department of MedicineJersey Shore University Medical CenterNeptune CityNew JerseyUSA
| | - Sowmya Dandu
- Department of MedicineJersey Shore University Medical CenterNeptune CityNew JerseyUSA
| | - Temidayo Abe
- Department of CardiologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Jesus Almendral
- Department of CardiologyJersey Shore University Medical CenterNeptune CityNew JerseyUSA
| | - Joseph Heaton
- Department of MedicineJersey Shore University Medical CenterNeptune CityNew JerseyUSA
| | - Riple Hansalia
- Department of CardiologyJersey Shore University Medical CenterNeptune CityNew JerseyUSA
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Roth HR, Reinert JP. Methylxanthine Derivatives in the Treatment of Sinus Node Dysfunction: A Systematic Review. Cardiol Rev 2023:00045415-990000000-00159. [PMID: 37909739 DOI: 10.1097/crd.0000000000000609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
While the chronotropic effects of theophylline and aminophylline are well-known, their clinical application in the treatment of sinus node dysfunction has not been established in a review. The purpose of this systematic review is to evaluate the efficacy and safety of methylxanthines in the treatment of bradyarrhythmias associated with sinus node dysfunction. A systematic review was conducted in accordance with PRISMA guidelines on Embase, PubMed, MEDLINE, Cochrane Central, Web of Science, SciELO, Korean Citation Index, Global Index Medicus, and CINAHL through June 2023. A total of 607 studies were identified through the literature search. After applying the inclusion and exclusion criteria, 14 studies were included in this review. The causes of bradyarrhythmias involving the sinoatrial node included acute cervical spinal cord injury, coronavirus disease of 2019, carotid sinus syncope, chronotropic incompetence, heart transplant, and chronic sinus node dysfunction. Theophylline and aminophylline were shown to be effective for increasing heart rate and reducing the reoccurrence of bradyarrhythmias. The data on symptom resolution was conflicting. While many case studies reported a resolution of symptoms, a randomized controlled trial reported no significant difference in symptom scores between the control, theophylline, and pacemaker groups in the treatment of sick sinus syndrome. The incidence of adverse effects was low across all study designs. The data suggests methylxanthines may be useful as an alternative or bridge to nonpharmacologic pacing; however, dosing has yet to be established for various indications. Overall, methylxanthines proved safe and effective as a pharmacologic therapy for bradyarrhythmic manifestations of sinus node dysfunction.
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Affiliation(s)
- Hunter R Roth
- From the Department of Pharmacy Practice, The University of Toledo College of Pharmacy and Pharmaceutical Sciences, Toledo, OH
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5
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Dayco J, Pawloski J, Sokolowski C, Patel D, Rits M, Goodrich G, Erdem S, Alraies MC. Extracorporeal Membrane Oxygenation (ECMO) Cannula Stimulation of the Carotid Sinus Causing Bradycardic Pauses in a Patient With COVID-19. Cureus 2023; 15:e37652. [PMID: 37200657 PMCID: PMC10188216 DOI: 10.7759/cureus.37652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/20/2023] Open
Abstract
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) cannulation is a potential cause of episodic bradycardia during an intensive care course because of the proximal cannula insertion site being in the vicinity of the carotid sinus. Herein, we report the case of episodic bradycardia throughout a multi-week intensive care stay of a VV-ECMO recipient due to a severe coronavirus disease 2019 (COVID-19) infection that did not emerge for the rest of the patient's hospitalization after decannulation.
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Affiliation(s)
- John Dayco
- Internal Medicine, Wayne State University Detroit Medical Center, Detroit, USA
| | - Justin Pawloski
- Internal Medicine, Wayne State University Detroit Medical Center, Detroit, USA
| | - Caleb Sokolowski
- Internal Medicine, Wayne State University Detroit Medical Center, Detroit, USA
| | - Dhruvil Patel
- Internal Medicine, Wayne State University Detroit Medical Center, Detroit, USA
| | - Micheal Rits
- Internal Medicine, Wayne State University Detroit Medical Center, Detroit, USA
| | - Grace Goodrich
- Internal Medicine, Wayne State University Detroit Medical Center, Detroit, USA
| | - Saliha Erdem
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - M Chadi Alraies
- Cardiology, Wayne State University Detroit Medical Center, Detroit, USA
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6
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Itoh T, Kobayashi T, Oshikiri Y, Arakawa Y, Satoh M, Morino Y. Clinical and electrocardiographic characteristics in patients with fulminant myocarditis. J Arrhythm 2022; 38:763-771. [PMID: 36237853 PMCID: PMC9535750 DOI: 10.1002/joa3.12751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/08/2022] [Accepted: 06/23/2022] [Indexed: 12/04/2022] Open
Abstract
Background The purpose of this study was to evaluate clinical and electrocardiographic characteristics in patients with fulminant myocarditis. Methods A total of 72 patients were divided into three groups: pericarditis (control: n = 25), acute myocarditis (n = 27), and fulminant myocarditis (n = 20). Patients' characteristics and electrocardiograms on admission were retrospectively analyzed in the three groups. Results BNP levels in the fulminant group were significantly higher than those in the other two groups. ST elevation was observed at lead aVR in the fulminant myocarditis group, whereas ST depression was observed at lead aVR in the other groups (p = .001). The maximum degree of ST elevation among the three groups was similar. However, the number of ST-elevation leads in the fulminant myocarditis group was significantly lower than that in the other groups (p = .004). The voltage of R wave in lead V5 in the fulminant myocarditis group was significantly lower than that in the other groups (p = .005). Moreover, in the Cabrera sequence, the prevalence of ST elevation in the inferior leads, aVR, and V3-V6 in the fulminant myocarditis group was significantly or nearly significantly lower than that in the other groups. Conclusions In fulminant myocarditis, ST-segment elevation was observed in lead aVR, and contrarily, the number and extent of ST-segment elevation and R wave voltage were smaller than those in the other groups. These results suggest that the number of myocytes with maintained action potential may be reduced following progressive myocardial damage and interstitial edema due to severe inflammation.
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Affiliation(s)
- Tomonori Itoh
- Division of Cardiology, Department of Internal MedicineIwate Medical UniversityShiwa‐gunJapan
- Division of Community Medicine, Department of Medical EducationIwate Medical UniversityShiwa‐gunJapan
| | - Takamasa Kobayashi
- Division of Cardiology, Department of Internal MedicineIwate Medical UniversityShiwa‐gunJapan
| | - Yuya Oshikiri
- Division of Cardiology, Department of Internal MedicineIwate Medical UniversityShiwa‐gunJapan
| | - Yumeka Arakawa
- School of MedicineIwate Medical UniversityShiwa‐gunJapan
| | - Mamoru Satoh
- Division of Biomedical Information Analysis, Institute for Biomedical SciencesIwate Medical UniversityShiwa‐gunJapan
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal MedicineIwate Medical UniversityShiwa‐gunJapan
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7
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Schreiber A, Bauzon JS, Batra K, Mohammed S, Lee K, Houshmand N, Pham U, Cosme C, Inciong K, Al-Taweel O, Nasser K, Rana J, Sossou C, Go A, Hawwass D, Diep J, Ahsan CH. Clinical Characteristics and Implications of Bradycardia in COVID-19 Patients Treated with Remdesivir: A Single-Center Retrospective Cohort Study. Clin Drug Investig 2022; 42:763-774. [PMID: 35978159 PMCID: PMC9385079 DOI: 10.1007/s40261-022-01187-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 12/15/2022]
Abstract
Background and Objectives Remdesivir is an antiviral drug used to treat coronavirus disease 2019 (COVID-19) with a relatively obscure cardiac effect profile. Previous studies have reported bradycardia associated with remdesivir, but few have examined its clinical characteristics. The objective of this study was to investigate remdesivir associated bradycardia and its associated clinical characteristics and outcomes. Methods This is a single-institution retrospective study that investigated bradycardia in 600 patients who received remdesivir for treatment of COVID-19. A total of 375 patients were included in the study after screening for other known causes of bradycardia (atrioventricular [AV] nodal blockers). All patients were analyzed for episodes of bradycardia from when remdesivir was initiated up to 5 days after completion, a time frame based on the drug’s putative elimination half-life. Univariate and multivariate statistical tests were conducted to analyze the data. Results The mean age of the sample was 56.63 ± 13.23 years. Of patients who met inclusion criteria, 49% were found to have bradycardia within 5 days of remdesivir administration. Compared to the cohort without a documented bradycardic episode, patients with bradycardia were significantly more likely to experience inpatient mortality (22% vs 12%, p = 0.01). The patients with bradycardia were found to have marginally higher serum D-dimer levels (5.2 vs 3.4 µg/mL, p = 0.05) and were more likely to undergo endotracheal intubation (28% vs 14%, p = 0.008). Male sex, hyperlipidemia, and bradycardia within 5 days of completing remdesivir were significant predictors of inpatient mortality. No significant differences in length of stay were found. Conclusions Bradycardia that occurs during or shortly after remdesivir treatment in COVID-19 patients may be associated with an increased rate of in-hospital mortality. However, COVID-19 and its cardiac complications cannot be excluded as potential contributors of bradycardia in the present study. Future studies are needed to further delineate the cardiac characteristics of COVID-19 and remdesivir. Supplementary Information The online version contains supplementary material available at 10.1007/s40261-022-01187-x.
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Affiliation(s)
- Ariyon Schreiber
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas (UNLV), 2040 W. Charleston Blvd., Mail Stop: 3070, Las Vegas, NV, 89102-2244, USA.
| | - Justin S Bauzon
- Department of Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
| | - Kavita Batra
- Department of Medical Education & Office of Research, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
| | - Salman Mohammed
- Department of Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
| | - Kevin Lee
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas (UNLV), 2040 W. Charleston Blvd., Mail Stop: 3070, Las Vegas, NV, 89102-2244, USA
| | - Nazanin Houshmand
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas (UNLV), 2040 W. Charleston Blvd., Mail Stop: 3070, Las Vegas, NV, 89102-2244, USA
| | - Uyen Pham
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas (UNLV), 2040 W. Charleston Blvd., Mail Stop: 3070, Las Vegas, NV, 89102-2244, USA
| | - Celica Cosme
- Department of Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
| | - Kim Inciong
- Department of Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
| | - Omar Al-Taweel
- Department of Cardiology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
| | - Keaton Nasser
- Department of Cardiology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
| | - Jibran Rana
- Department of Cardiology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
| | - Chris Sossou
- Department of Cardiology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
| | - Ariel Go
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas (UNLV), 2040 W. Charleston Blvd., Mail Stop: 3070, Las Vegas, NV, 89102-2244, USA
| | - Dalia Hawwass
- Department of Cardiology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
| | - Jimmy Diep
- Department of Cardiology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
| | - Chowdhury H Ahsan
- Department of Cardiology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, USA
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8
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Bebtelovimab-Induced Bradycardia Leading to Cardiac Arrest. Crit Care Explor 2022; 4:e0747. [PMID: 36003828 PMCID: PMC9394688 DOI: 10.1097/cce.0000000000000747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Bebtelovimab is a monoclonal antibody used to prevent progression of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Complications of SARS-CoV-2 infection can include cardiac effects including sinus bradycardia.
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9
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Natarajan A, Su HW, Heneghan C. Occurrence of Relative Bradycardia and Relative Tachycardia in Individuals Diagnosed With COVID-19. Front Physiol 2022; 13:898251. [PMID: 35620612 PMCID: PMC9127385 DOI: 10.3389/fphys.2022.898251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/08/2022] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 disease caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has become one of the worst global pandemics of the century. Wearable devices are well suited for continuously measuring heart rate. Here we show that the Resting Heart Rate is modified for several weeks following a COVID-19 infection. The Resting Heart Rate shows 3 phases: 1) elevated during symptom onset, with average peak increases relative to the baseline of 1.8% (3.4%) for females (males), 2) decrease thereafter, reaching a minimum on average ≈13 days after symptom onset, and 3) subsequent increase, reaching a second peak on average ≈28 days from symptom onset, before falling back to the baseline ≈112 days from symptom onset. All estimates vary with disease severity.
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10
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Abstract
PURPOSE OF REVIEW Cardiovascular involvement in coronavirus disease 2019 (COVID-19) is relatively common and portends an increased risk of morbidity and mortality. Manifestations of myocardial injury may exhibit significant overlap and result in diagnostic uncertainty. This review will summarize recent literature around cardiovascular complications of COVID-19. RECENT FINDINGS Venous thromboembolism, atrial fibrillation, and type II myocardial infarction are observed commonly in COVID-19, while severe acute respiratory syndrome coronavirus 2 viral myocarditis remains quite rare. Although infrequent, COVID-19 vaccination has been associated with myocarditis and pericarditis in young individuals. SUMMARY Various forms of COVID-19-related myocardial injury have been associated with increased utilization of mechanical ventilation, hemodynamic deterioration, and mortality. Manifestations of myocardial injury in COVID-19 are varied, but share common drivers of illness including sequelae of sepsis, immune-mediated factors, and a prothrombotic state. Understanding the forms of myocardial injury in COVID-19 may aid in rapid diagnosis and treatment.
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Affiliation(s)
| | - Barbara Lawson
- Division of Interventional Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
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11
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Umeh C, Giberson C, Kumar S, Aseri M, Barve P. A Multicenter Retrospective Analysis on the Etiology of Bradycardia in COVID-19 Patients. Cureus 2022; 14:e21294. [PMID: 35186556 PMCID: PMC8846448 DOI: 10.7759/cureus.21294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 02/06/2023] Open
Abstract
Introduction Bradycardia has been reported in the setting of SARS-CoV2 (COVID-19) and appears to be an important cardiac manifestation with an association of mortality. However, the etiology of bradycardia in COVID-19 remains unclear. Therefore, this study aims to retrospectively investigate the potential causes of bradycardia in COVID-19 patients. Method The multicenter retrospective analysis consisted of 1,116 COVID-19 positive patients from March 2020 to March 2021. Bradycardia and severe bradycardia were defined as a sustained heart rate of <60 BPM and <50 BPM, respectively, on two separate occasions, a minimum of four hours apart during the hospitalization. End-of-life bradycardia was excluded from the study. Data were retrieved using a structured query language (SQL) program through the EMR, and data were analyzed using IBM SPSS 27.0 (IBM Corp., Armonk, NY). Logistic regression was used to study the bradycardic event and its association with remdesivir, beta-blockers, or steroids use during the patient's hospital stay. Result In the multivariate analysis, bradycardia was significantly associated with length of hospital stay (p<0.001), mortality (p=0.022), ventilator use (p=0.001), and steroid use (p=0.001). However, there was no significant association between bradycardia and remdesivir use (p=0.066) or beta-blocker use (p=0.789). Conclusion Our study showed that steroid use was protective against developing bradycardia in COVID-19 patients. Furthermore, remdesivir and the use of beta-blockers were not associated with bradycardia in COVID-19 patients. However, bradycardia was associated with both increased mortality and length of stay in the hospital. Therefore, future studies should focus on the mechanism of bradycardia in COVID-19 patients and the effect of bradycardia on patient outcomes.
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Affiliation(s)
| | | | - Sabina Kumar
- Internal Medicine, Hemet Global Medical Center, Hemet, USA
| | - Mahendra Aseri
- Data Engineering and Business Intelligence, Hemet Global Medical Center, Hemet, USA
| | - Pranav Barve
- Internal Medicine, Hemet Global Medical Center, Hemet, USA
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12
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Umeh C, Watanabe K, Tuscher L, Ranchithan S, Gupta R. Comparison of Clinical Characteristics and Outcomes of COVID-19 Between Young and Older Patients: A Multicenter, Retrospective Cohort Study. Cureus 2022; 14:e21785. [PMID: 35251855 PMCID: PMC8890849 DOI: 10.7759/cureus.21785] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 02/06/2023] Open
Abstract
Background Outcomes of coronavirus disease 2019 (COVID-19) have been reported to be different in the young and elderly populations. However, previous studies examining these characteristics and differences in outcomes between the two groups had a small sample size. Therefore, in this study, we evaluate the differences between young and elderly patients using a large multicenter dataset. Methodology We conducted a retrospective study of 1,116 consecutive COVID-19 patients admitted to two hospitals in southern California in the United States between March 2020 and March 2021. In this study, we categorized patients into two age groups: less than 65 years and 65 years and above. Finally, Kaplan-Meier and backward selection Cox multivariate regression analyses were done using mortality as the dependent variable. Results Our analysis showed increased survival in patients aged less than 65 years compared to those aged 65 years or above (p < 0.001). Furthermore, in patients aged 65 years and above, age (hazard ratio (HR) = 1.05; p < 0.001), C-reactive protein (CRP) (HR = 1.05; p < 0.001), and bradycardia (HR = 2.1; p < 0.001) were significantly associated with mortality. Similarly, CRP (HR 1.05; p = 0.02) was significantly associated with mortality in patients aged less than 65 years. However, contrary to many studies, being male (HR = 0.46; p = 0.002) was protective against mortality in patients aged less than 65 years. Conclusions Our study showed that the predictors of mortality in COVID-19 patients differed by age group. While age, CRP, and bradycardia were associated with mortality in those aged less than 65 years, only CRP was associated with mortality in those aged 65 years and above.
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Affiliation(s)
| | | | - Laura Tuscher
- Internal Medicine, Hemet Global Medical Center, Hemet, USA
| | - Sobiga Ranchithan
- Medicine and Surgery, American University of Antigua, St. John's, ATG
| | - Rahul Gupta
- Internal Medicine, Hemet Global Medical Center, Hemet, USA
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Jung LY, Kim JM, Ryu S, Lee CS. Relative bradycardia in patients with COVID-19. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2022; 23:22. [PMID: 36065390 PMCID: PMC9433131 DOI: 10.1186/s42444-022-00073-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/22/2022] [Indexed: 01/17/2023] Open
Abstract
Introduction Relative bradycardia(RB) is a relatively low heart rate response to rise in body temperature that occurs in several infectious diseases and can be an important clinical sign. In previous case reports, RB was presented in some patients with Coronavirus disease 2019 (COVID-19) COVID-19. Objective and Methods To investigate the correlation between temperature and heart rate, we retrospectively reviewed 249 febrile patients with documented COVID-19 patients. RB was defined as a rise in the heart rate from a basal heart rate of less than 10 beats/minute/°C rise in temperature. Results In this study, the prevalence of RB in patients with COVID-19 was 60.6%. When the HR at peak temperatures for patients with COVID-19 were compared with reference valve (general temperature-heart rate response in infectious disease), our findings demonstrate a relatively lower heart rate at all peak temperatures recorded. Despite differences in heart rate response, there were not significant differences in clinical outcomes (pulmonary manifestation, intensive care unit admission, Death). Conclusions Most patients with COVID-19 are associated with relative bradycardia, not related to clinical outcomes. RB in COVID-19 can be considered as the clinical features for differential diagnosis from other febrile conditions.
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Affiliation(s)
- Lae-Young Jung
- grid.411545.00000 0004 0470 4320Department of Internal Medicine, Jeonbuk National University Medical School, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeollabuk-do 54907 Republic of Korea ,grid.411545.00000 0004 0470 4320Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Jae-Min Kim
- grid.411545.00000 0004 0470 4320Department of Internal Medicine, Jeonbuk National University Medical School, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeollabuk-do 54907 Republic of Korea
| | - Sukhyun Ryu
- grid.411143.20000 0000 8674 9741Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Chang-Seop Lee
- grid.411545.00000 0004 0470 4320Department of Internal Medicine, Jeonbuk National University Medical School, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeollabuk-do 54907 Republic of Korea ,grid.411545.00000 0004 0470 4320Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
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14
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McKinnon JE, Wang DD, Zervos M, Saval M, Marshall-Nightengale L, Kilgore P, Pabla P, Szandzik E, Maksimowicz-McKinnon K, O'Neill WW. Safety and Tolerability of Hydroxychloroquine in healthcare workers and first responders for the prevention of COVID-19: WHIP COVID-19 Study. Int J Infect Dis 2021; 116:167-173. [PMID: 34954095 PMCID: PMC8695310 DOI: 10.1016/j.ijid.2021.12.343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 11/27/2022] Open
Abstract
Hydroxychloroquine chemoprophylaxis is safe in high-risk populations for COVID-19. No increased cardiovascular risks were observed with hydroxychloroquine chemoprophylaxis. Adverse events were similar between placebo and hydroxychloroquine treatment arms.
Background Health care workers (HCW) are among the highest risk groups for acquisition of COVID-19 because of occupational exposures. The WHIP COVID-19 Study aimed to evaluate the safety and efficacy of hydroxychloroquine (HCQ) as chemoprophylaxis for SARS-CoV-2 infection in this population. Methods HCW, first responders, and other occupationally high-risk participants were enrolled in a randomized, placebo-controlled clinical study of HCQ from April to October 2020. The trial compared daily versus weekly HCQ with placebo and with a prospective cohort on HCQ for autoimmune diseases. Participants were followed for 8 weeks. Serology or a positive polymerase chain reaction test was used to determine laboratory confirmed clinical cases. Results A total of 624 participants were randomized to placebo (n = 200), weekly HCQ (n = 201), daily HCQ (n = 197). For the primary safety end point, 279 (44.7%) participants experienced adverse event (AE) level II or lower (total AEs n = 589), similar rates in all randomized groups (P = .188) with no hospitalizations or interventions required. Only 4 laboratory confirmed COVID-19 cases occurred, with 2 in the placebo arm and one in each HCQ randomized arm. Conclusions This randomized placebo-controlled trial was able to demonstrate the safety of HCQ outpatient chemoprophylaxis in high-risk groups against COVID-19. Future studies of chemoprophylaxis for SARS-CoV-2 are needed as the epidemic continues worldwide.
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Affiliation(s)
- J E McKinnon
- Infectious Disease, Henry Ford Hospital, Detroit, Michigan.
| | - D D Wang
- Division of Cardiovascular Disease, Center for Structural Heart, Henry Ford Hospital, Detroit, Michigan
| | - M Zervos
- Infectious Disease, Henry Ford Hospital, Detroit, Michigan
| | - M Saval
- Division of Cardiovascular Disease, Center for Structural Heart, Henry Ford Hospital, Detroit, Michigan
| | - L Marshall-Nightengale
- Division of Cardiovascular Disease, Center for Structural Heart, Henry Ford Hospital, Detroit, Michigan; Public Health Sciences, Henry Ford Hospital, Detroit, Michigan
| | - P Kilgore
- Infectious Disease, Henry Ford Hospital, Detroit, Michigan
| | - P Pabla
- Pharmacy, Henry Ford Hospital, Detroit, Michigan
| | - E Szandzik
- Pharmacy, Henry Ford Hospital, Detroit, Michigan
| | | | - W W O'Neill
- Division of Cardiovascular Disease, Center for Structural Heart, Henry Ford Hospital, Detroit, Michigan
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15
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Arvinti B, Iacob ER, Isar A, Iacob D, Costache M. Automated Medical Care: Bradycardia Detection and Cardiac Monitoring of Preterm Infants. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1199. [PMID: 34833417 PMCID: PMC8625917 DOI: 10.3390/medicina57111199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/19/2021] [Accepted: 11/01/2021] [Indexed: 02/07/2023]
Abstract
Background and Objectives: Prematurity of birth occurs before the 37th week of gestation and affects up to 10% of births worldwide. It is correlated with critical outcomes; therefore, constant monitoring in neonatal intensive care units or home environments is required. The aim of this work was to develop solutions for remote neonatal intensive supervision systems, which should assist medical diagnosis of premature infants and raise alarm at cardiac abnormalities, such as bradycardia. Additionally, the COVID-19 pandemic has put a worldwide stress upon the medical staff and the management of healthcare units. Materials and Methods: A traditional medical diagnosing scheme was set up, implemented with the aid of powerful mathematical operators. The algorithm was tailored to the infants' personal ECG characteristics and was tested on real ECG data from the publicly available PhysioNet database "Preterm Infant Cardio-Respiratory Signals Database". Different processing problems were solved: noise filtering, baseline drift removal, event detection and compression of medical data using the à trous wavelet transform. Results: In all 10 available clinical cases, the bradycardia events annotated by the physicians were correctly detected using the RR intervals. Compressing the ECG signals for remote transmission, we obtained compression ratios (CR) varying from 1.72 to 7.42, with the median CR value around 3. Conclusions: We noticed that a significant amount of noise can be added to a signal while monitoring using standard clinical sensors. We tried to offer solutions for these technical problems. Recent studies have shown that persons infected with the COVID-19 disease are frequently reported to develop cardiovascular symptoms and cardiac arrhythmias. An automatic surveillance system (both for neonates and adults) has a practical medical application. The proposed algorithm is personalized, no fixed reference value being applied, and the algorithm follows the neonate's cardiac rhythm changes. The performance depends on the characteristics of the input ECG. The signal-to-noise ratio of the processed ECG was improved, with a value of up to 10 dB.
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Affiliation(s)
- Beatrice Arvinti
- Fundamentals of Physics for Engineers Department, “Politehnica” University Timisoara, Bd. Vasile Pârvan 2, 300223 Timisoara, Romania;
| | - Emil Radu Iacob
- Department of Pediatric Surgery, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Alexandru Isar
- Faculty of Electronics, Telecommunications and Information Technologies, “Politehnica” University Timisoara, Bd. Vasile Pârvan 2, 300223 Timisoara, Romania;
| | - Daniela Iacob
- Department of Neonatology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Marius Costache
- Fundamentals of Physics for Engineers Department, “Politehnica” University Timisoara, Bd. Vasile Pârvan 2, 300223 Timisoara, Romania;
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