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Nikoo MH, Sadeghi A, Estedlal A, Fereidooni R, Dehdari Ebrahimi N, Maktabi A, Kamgar M, Mehran F, Mehdibeygi O, Esfandiari H, Taherinezhad Tayebi M, Heydari ST. Conduction system disorders and electro cardiographic findings in COVID-19 deceased patients in 2021, Shiraz, Iran. World J Cardiol 2022; 14:617-625. [PMID: 36605421 PMCID: PMC9808027 DOI: 10.4330/wjc.v14.i12.617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/21/2022] [Accepted: 10/31/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Cardiac conduction disorders and electrocardiographic (ECG) changes may occur as a manifestation of coronavirus disease 2019 (COVID-19), especially in severe cases.
AIM To describe conduction system disorders and their association with other electrocardiographic parameters in patients who died of COVID-19.
METHODS In this cross-sectional study, electrocardiographic and clinical data of 432 patients who expired from COVID-19 between August 1st, 2021, and December 1st, 2021, in a tertiary hospital were reviewed.
RESULTS Among 432 patients who died from COVID-19, atrioventricular block (AVB) was found in 40 (9.3%). Among these 40 patients, 28 (6.5%) suffered from 1st degree AVB, and 12 (2.8%) suffered from complete heart block (CHB). Changes in ST-T wave, compatible with myocardial infarction or localized myocarditis, appeared in 189 (59.0%). Findings compatible with myocardial injury, such as fragmented QRS and prolonged QTc, were found in 91 patients (21.1%) and 28 patients (6.5%), respectively. In patients who died of COVID-19, conduction disorder was unrelated to any underlying medical condition. Fragmented QRS, axis deviation, and ST-T changes were significantly related to conduction system disorder in patients who died of COVID-19 (P value < 0.05).
CONCLUSION Conduction system disorders are associated with several other ECG abnormalities, especially those indicative of myocardial ischemia or inflammation. Most patients (73.14%) who died of COVID-19 demonstrated at least one ECG abnormality parameter. Since a COVID-19 patient's ECG gives important information regarding their cardiac health, our findings can help develop a risk stratification method for at-risk COVID-19 patients in future studies.
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Affiliation(s)
- Mohammad Hossein Nikoo
- Non-communicable Diseases Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Sadeghi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Estedlal
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Fereidooni
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Amirhossein Maktabi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahtab Kamgar
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Mehran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Omid Mehdibeygi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Haleh Esfandiari
- Non-communicable Diseases Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Seyed Taghi Heydari
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Nagamine T, Randhawa S, Nishimura Y, Huang R, Leesutipornchai T, Benavente K, Yoshimura S, Zhang J, Kanitsorphan C. Characteristics of bradyarrhythmia in patients with COVID-19: Systematic scoping review. Pacing Clin Electrophysiol 2022; 45:556-566. [PMID: 35182433 PMCID: PMC9115401 DOI: 10.1111/pace.14466] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/16/2022] [Accepted: 01/30/2022] [Indexed: 11/26/2022]
Abstract
COVID‐19 has recently been associated with the development of bradyarrhythmias, although its mechanism is still unclear. We aim to summarize the existing evidence regarding bradyarrhythmia in COVID‐19 and provide future directions for research. Following the PRISMA Extension for Scoping Reviews, we searched MEDLINE and EMBASE for all peer‐reviewed articles using keywords including“Bradycardia,” “atrioventricular block,” and “COVID‐19″ from their inception to October 13, 2021. Forty‐three articles, including 11 observational studies and 59 cases from case reports and series, were included in the systematic review. Although some observational studies reported increased mortality in those with bradyarrhythmia and COVID‐19, the lack of comparative groups and small sample sizes hinder the ability to draw definitive conclusions. Among 59 COVID‐19 patients with bradycardia from case reports and series, bradycardia most often occurred in those with severe or critical COVID‐19, and complete heart block occurred in the majority of cases despite preserved LVEF (55.9%). Pacemaker insertion was required in 76.3% of the patients, most of which were permanent implants (45.8%). This systematic review summarizes the current evidence and characteristics of bradyarrhythmia in patients with COVID‐19. Further studies are critical to assess the reversibility of bradyarrhythmia in COVID‐19 patients and to clarify potential therapeutic targets including the need for permanent pacing.
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Affiliation(s)
- Todd Nagamine
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, 96813, USA
| | - Sandeep Randhawa
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, 96813, USA
| | - Yoshito Nishimura
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, 96813, USA
| | - Ricky Huang
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, 96813, USA
| | - Thiratest Leesutipornchai
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, 96813, USA
| | - Kevin Benavente
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, 96813, USA
| | - Stephanie Yoshimura
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, 96813, USA
| | - James Zhang
- Queen's Heart Institute, The Queen's Medical Center, Honolulu, HI, 96813, USA
| | - Chanavuth Kanitsorphan
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, 96813, USA
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Tovia-Brodie O, Rav Acha M, Belhassen B, Gasperetti A, Schiavone M, Forleo GB, Guevara-Valdivia ME, Ruiz DV, Lellouche N, Hamon D, Castagno D, Bellettini M, De Ferrari GM, Laredo M, Carvès JB, Ignatiuk B, Pasquetto G, De Filippo P, Malanchini G, Pavri BB, Raphael C, Rivetti L, Mantovan R, Chinitz J, Harding M, Boriani G, Casali E, Wan EY, Biviano A, Macias C, Havranek S, Lazzerini PE, Canu AM, Zardini M, Conte G, Cano Ó, Casella M, Rudic B, Omelchenko A, Mathuria N, Upadhyay GA, Danon A, Schwartz AL, Maury P, Nakahara S, Goldenberg G, Schaerli N, Bereza S, Auricchio A, Glikson M, Michowitz Y. Implantation of cardiac electronic devices in active COVID-19 patients: Results from an international survey. Heart Rhythm 2022; 19:206-216. [PMID: 34710561 PMCID: PMC8547796 DOI: 10.1016/j.hrthm.2021.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/16/2021] [Accepted: 10/20/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Cardiac implantable electronic device (CIED) implantation rates as well as the clinical and procedural characteristics and outcomes in patients with known active coronavirus disease 2019 (COVID-19) are unknown. OBJECTIVE The purpose of this study was to gather information regarding CIED procedures during active COVID-19, performed with personal protective equipment, based on an international survey. METHODS Fifty-three centers from 13 countries across 4 continents provided information on 166 patients with known active COVID-19 who underwent a CIED procedure. RESULTS The CIED procedure rate in 133,655 hospitalized COVID-19 patients ranged from 0 to 16.2 per 1000 patients (P <.001). Most devices were implanted due to high-degree/complete atrioventricular block (112 [67.5%]) or sick sinus syndrome (31 [18.7%]). Of the 166 patients in the study survey, the 30-day complication rate was 13.9% and the 180-day mortality rate was 9.6%. One patient had a fatal outcome as a direct result of the procedure. Differences in patient and procedural characteristics and outcomes were found between Europe and North America. An older population (76.6 vs 66 years; P <.001) with a nonsignificant higher complication rate (16.5% vs 7.7%; P = .2) was observed in Europe vs North America, whereas higher rates of critically ill patients (33.3% vs 3.3%; P <.001) and mortality (26.9% vs 5%; P = .002) were observed in North America vs Europe. CONCLUSION CIED procedure rates during known active COVID-19 disease varied greatly, from 0 to 16.2 per 1000 hospitalized COVID-19 patients worldwide. Patients with active COVID-19 infection who underwent CIED implantation had high complication and mortality rates. Operators should take these risks into consideration before proceeding with CIED implantation in active COVID-19 patients.
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Affiliation(s)
- Oholi Tovia-Brodie
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
| | - Moshe Rav Acha
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - Bernard Belhassen
- Heart Institute, Hadassah University Hospital, Jerusalem, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alessio Gasperetti
- Cardiology Unit, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Marco Schiavone
- Cardiology Unit, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | | | - Milton E Guevara-Valdivia
- UMAE Hospital de Especialidades Dr. Antonio Fraga Mouret, CMN La Raza IMSS, CDMX, Mexico City, México
| | - David Valdeolivar Ruiz
- UMAE Hospital de Especialidades Dr. Antonio Fraga Mouret, CMN La Raza IMSS, CDMX, Mexico City, México
| | - Nicolas Lellouche
- Henri Mondor University Hospital Cardiology Unit Creteil, Paris, France
| | - David Hamon
- Henri Mondor University Hospital Cardiology Unit Creteil, Paris, France
| | - Davide Castagno
- Division of Cardiology, Department of Medical Sciences, "Città della Salute della Scienza" Hospital, University of Turin, Turin, Italy
| | - Matteo Bellettini
- Division of Cardiology, Department of Medical Sciences, "Città della Salute della Scienza" Hospital, University of Turin, Turin, Italy
| | - Gaetano M De Ferrari
- Division of Cardiology, Department of Medical Sciences, "Città della Salute della Scienza" Hospital, University of Turin, Turin, Italy
| | - Mikael Laredo
- AP. HP-Sorbonne Université, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jean-Baptiste Carvès
- AP. HP-Sorbonne Université, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Barbara Ignatiuk
- Ospedali Riuniti Padova Sud "Madre Teresa di Calcutta", Monselice, Italy
| | | | - Paolo De Filippo
- Cardiac Electrophysiology and Pacing Unit, Papa Giovanni XXIII Hospital, Bergamo (BG), Italy
| | - Giovanni Malanchini
- Cardiac Electrophysiology and Pacing Unit, Papa Giovanni XXIII Hospital, Bergamo (BG), Italy
| | - Behzad B Pavri
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Craig Raphael
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Luigi Rivetti
- Department of Cardiology, "S. Maria dei Battuti" Hospital, AULSS 2 Veneto, Conegliano (TV), Italy
| | - Roberto Mantovan
- Department of Cardiology, "S. Maria dei Battuti" Hospital, AULSS 2 Veneto, Conegliano (TV), Italy
| | - Jason Chinitz
- Department of Cardiology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell Health, South Shore University Hospital, Bay Shore, New York
| | - Melissa Harding
- Department of Cardiology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell Health, South Shore University Hospital, Bay Shore, New York
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Edoardo Casali
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Elaine Y Wan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Angelo Biviano
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Carlos Macias
- UCLA Cardiac Arrhythmia Center, Los Angeles, California
| | - Stepan Havranek
- 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Pietro Enea Lazzerini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy, and Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Antonio M Canu
- Azienda Ospedaliero-Universitaria Pisana, Cardiothoracic and Vascular Department, Cardiovascular Unit II, Pisa, Italy
| | - Marco Zardini
- Division of Cardiology, University Hospital "Ospedale Maggiore", Parma, Italy
| | - Giulio Conte
- Electrophysiology Unit, Department of Cardiology, Istituto Cardiocentro Ticino, Lugano, Switzerland
| | - Óscar Cano
- Arrhythmia Section, Department of Cardiology, Hospital Universitari i Politècnic La Fe, Instituto de Investigación Sanitaria La Fe, Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), Valencia, Spain
| | - Michela Casella
- Clinic of Cardiology and Arrhythmology, University Hospital "Ospedali Riuniti", Department of Clinical, Special and Dental Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Boris Rudic
- 1st Department of Medicine-Cardiology, University Medical Centre Mannheim, Germany, and German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | | | - Nilesh Mathuria
- Division of Cardiac Electrophysiology, Houston Methodist DeBakey Cardiology Associates, Houston, Texas
| | - Gaurav A Upadhyay
- Center for Arrhythmia Care, Division of Cardiology, Pritzker School of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Asaf Danon
- Electrophysiology Unit, Cardiology Department, Carmel Medical Center, Haifa, Israel
| | - Arie Lorin Schwartz
- Cardiology Department, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Philippe Maury
- Cardiology, University Hospital Rangueil, Toulouse, France
| | - Shiro Nakahara
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Gustavo Goldenberg
- Rabin Medical Center, Petach Tikva, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nicolas Schaerli
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sergiy Bereza
- Cardiology Department, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Angelo Auricchio
- Electrophysiology Unit, Department of Cardiology, Istituto Cardiocentro Ticino, Lugano, Switzerland
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - Yoav Michowitz
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel
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Shams P, Ali J, Saadia S, Khan AH, Sultan FAT, Tai J. COVID-19 BBIBP-CorV vaccine and transient heart block - A phenomenon by chance or a possible correlation - A case report. Ann Med Surg (Lond) 2021; 71:102956. [PMID: 34667594 PMCID: PMC8518134 DOI: 10.1016/j.amsu.2021.102956] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE Bradyarrhythmia during COVID19 illness carries prognostic significance. Electrophysiological side effects of COVID19 vaccine remain largely unknown. It is imperative to report nature of cardiovascular side effects of the vaccine. CASE PRESENTATION An 80 years-old-man presented with complains of dizziness, trepidation and shortness of breath following his first shot of COVID-19 BBIBP-CorV (Sino-pharm). ECG on arrival showed 2:1 atrioventricular block with an underlying old left bundle branch block. The AV block changed into Mobitz type-I over the course of next 2 days and into a sinus 1:1 conduction on fourth day of presentation. However, our patient underwent permanent pacemaker implantation due to the underlying conduction tissue disease and intermittent 2:1 AV block during the hospital stay. CLINICAL DISCUSSION It is likely that patients with an already diseased conduction system are at an increased risk of worsening of AV block following inoculation of the vaccine. Vaccine associated AV blocks are likely to be reversible. Presence of prior coronary artery disease and electrical abnormalities are important considerations. CONCLUSION COVID-19 vaccine may have added side effects in subjects with known heart disease. Humoral response towards the vaccine might interfere with the conduction system of the heart and more so in patients with diseased and scarred myocardium.
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Affiliation(s)
- Pirbhat Shams
- Section of Cardiology, Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | - Jamshed Ali
- Section of Cardiology, Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | - Sheema Saadia
- Section of Cardiology, Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | - Aamir Hameed Khan
- Section of Cardiology, Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | - Fateh Ali Tipoo Sultan
- Section of Cardiology, Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | - Javed Tai
- Section of Cardiology, Department of Medicine, The Aga Khan University, Karachi, Pakistan
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Salamanna F, Veronesi F, Martini L, Landini MP, Fini M. Post-COVID-19 Syndrome: The Persistent Symptoms at the Post-viral Stage of the Disease. A Systematic Review of the Current Data. Front Med (Lausanne) 2021; 8:653516. [PMID: 34017846 PMCID: PMC8129035 DOI: 10.3389/fmed.2021.653516] [Citation(s) in RCA: 120] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/10/2021] [Indexed: 01/08/2023] Open
Abstract
Whilst the entire world is battling the second wave of COVID-19, a substantial proportion of patients who have suffered from the condition in the past months are reporting symptoms that last for months after recovery, i. e., long-term COVID-19 symptoms. We aimed to assess the current evidence on the long-term symptoms in COVID-19 patients. We did a systematic review on PubMed, Web of Science, EMBASE, and Google Scholar from database inception to February 15, 2021, for studies on long-term COVID-19 symptoms. We included all type of papers that reported at least one long-term COVID-19 symptom. We screened studies using a standardized data collection form and pooled data from published studies. Cohort cross-sectional, case-report, cases-series, case-control studies, and review were graded using specific quality assessment tools. Of 11,361 publications found following our initial search we assessed 218 full-text articles, of which 145 met all selection criteria. We found that 20.70% of reports on long-term COVID-19 symptoms were on abnormal lung functions, 24.13% on neurologic complaints and olfactory dysfunctions, and 55.17% on specific widespread symptoms, mainly chronic fatigue, and pain. Despite the relatively high heterogeneity of the reviewed studies, our findings highlighted that a noteworthy proportion of patients who have suffered from SARS-CoV-2 infection present a "post-COVID syndrome." The multifaceted understanding of all aspects of the COVID-19 pandemic, including these long-term symptoms, will allow us to respond to all the global health challenges, thus paving the way to a stronger public health.
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Affiliation(s)
- Francesca Salamanna
- IRCCS Istituto Ortopedico Rizzoli, Complex Structure of Surgical Sciences and Technologies, Bologna, Italy
| | - Francesca Veronesi
- IRCCS Istituto Ortopedico Rizzoli, Complex Structure of Surgical Sciences and Technologies, Bologna, Italy
| | - Lucia Martini
- IRCCS Istituto Ortopedico Rizzoli, Complex Structure of Surgical Sciences and Technologies, Bologna, Italy
| | | | - Milena Fini
- IRCCS Istituto Ortopedico Rizzoli, Complex Structure of Surgical Sciences and Technologies, Bologna, Italy
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