COVID-19 Vaccination and Cardiac Arrhythmias: A Review

PURPOSE OF REVIEW

In this review, we aim to delve into the existing literature, seeking to uncover the mechanisms, investigate the electrocardiographic changes, and examine the treatment methods of various cardiac arrhythmias that occur after administration of the COVID-19 vaccine.

RECENT FINDINGS

A global survey has exposed an incidence of arrhythmia in 18.27% of hospitalized COVID-19 patients. Furthermore, any type of COVID-19 vaccine - be it mRNA, adenovirus vector, whole inactivated, or protein subunit - appears to instigate cardiac arrhythmias. Among the cardiac adverse events reported post-COVID-19 vaccination, myocarditis emerges as the most common and is thought to be a potential cause of bradyarrhythmia. When a patient post-COVID-19 vaccination presents a suspicion of cardiac involvement, clinicians should perform a comprehensive history and physical examination, measure electrolyte levels, conduct ECG, and carry out necessary imaging studies. In our extensive literature search, we uncovered various potential mechanisms that might lead to cardiac conduction abnormalities and autonomic dysfunction in patients who have received the COVID-19 vaccine. These mechanisms encompass direct viral invasion through molecular mimicry/spike (S) protein production, an escalated inflammatory response, hypoxia, myocardial cell death, and the eventual scar/fibrosis. They correspond to a range of conditions including atrial tachyarrhythmias, bradyarrhythmia, ventricular arrhythmias, sudden cardiac death, and the frequently occurring myocarditis. For treating these COVID-19 vaccination-induced arrhythmias, we should incorporate general treatment strategies, similar to those applied to arrhythmias from other causes.

Seizure-Induced Cardiomyopathy: A Case of Takotsubo Cardiomyopathy Following an Epileptic Event

We present a case, written with the assistance of the Chat Generative Pre-training Transformer (ChatGPT) Artificial Intelligence (AI), of a 75-year-old female with a history of hypertension, epilepsy, coronary artery disease, and alcohol use disorder. She presented with a tonic-clonic seizure, tachycardia, and a cyanotic right hand. Diagnostic tests revealed stress-induced cardiomyopathy, patent bilateral subclavian and axillary arteries with heavy calcification of bilateral upper extremity arteries, and a small filling defect in the segmental branch of the left lower lobe. The patient was started on antiepileptic medication, thiamine/folate, and heparin drip for limb ischemia. Despite treatment with multiple anti-arrhythmic agents, the patient developed cardiogenic shock and underwent left heart catheterization with Impella placement. The Impella was removed 72 hours after placement, and the patient was started on low-dose Milrinone and Levophed for hemodynamic support. The patient eventually recovered and was discharged to long-term acute care.

Association of cardiac amyloidosis with valvular heart diseases – a nationwide analysis

Background

Association of cardiac amyloidosis (CA) with aortic stenosis (AS) is well known. There is limited data on the association of CA with other valvular heart diseases like aortic regurgitation (AR), mitral stenosis (MS), mitral regurgitation (MR), tricuspid stenosis (TS), tricuspid regurgitation (TR), pulmonary stenosis (PS) and regurgitation (PR).

Purpose

To assess the associations between valvular heart diseases and cardiac amyloidosis.

Methods

This is a retrospective observational study from hospitalizations between January 1, 2016, and December 31, 2019, using the National Inpatient Sample (NIS), the largest all-payer public database of hospital care data in the United States. We looked into associations between valvular heart diseases (VHD) and CA.

Results

From 2016 to 2019, a total of 4999 patients with a history of CA, 16,711 MS, 361,864 MR, 380,072 AS, 89,452 AR, 194 TS, 104,151 TR, 853 PS, 13,277 PR were identified. Compared to those without any history of CA, those with a history of CA had significantly higher associations with MR (6.4% vs 1.3%, p<0.001), AS (3.6% vs 1.3%, p<0.001), AR (1% vs 0.3%, p<0.001), TS (0.02% vs 0, p<0.033), TR (2.7% vs 0.4%, p<0.001), PR (0.4% vs 0.1%, p<0.001). Mean age of patients with history of CA in MS (73.7 years), MR (75.2 years), AS (81.4 years), AR (77.1 years), TS (82 years), TR (77.3 years), PR (78.1 years). Compared to males, females had higher incidence of MS (0.1% vs 0.03%, p<0.001) and lower incidence of AS (1.2% vs 1.6%, p<0.001) and AR (0.3% vs 0.4%, p<0.001).

Conclusion

There was a significantly higher association between CA and MR, AS, TR. Comparatively, patients with CA and MS were younger than those with other VHD.

Funding Acknowledgement

Type of funding sources: None.