Top Things to Know: Arrhythmias and Autonomic Dysfunction Associated With COVID-19
Published: October 14, 2024
Prepared by Anne Leonard MPH, RN, BSN – AHA National Senior Director, Science and Medicine
- Cardiac arrhythmias are commonly noted in patients during infections with and recovery from COVID-19.
- Arrhythmic manifestations span the spectrum of innocuous and benign to life-threatening and deadly.
- This statement examines the arrhythmias seen in COVID-19 patients: bradyarrhythmia, atrial fibrillation and flutter, and ventricular arrhythmias.
- The debate continues about the impact of the incident and exacerbated arrhythmias on the acute and chronic (recovery) phases of the illness. COVID-19 and the COVID-19 vaccine–associated myocardial inflammation and autonomic disruption remain a concern. This statement addresses these.
- This statement discusses postulated pathophysiological mechanisms contributing to these arrhythmias. Mechanisms include but are not limited to direct autonomic effects, hemodynamic disruption, and immune-related causes (e.g., inflammation and direct viral injury).
- This statement also explores a proposed pathophysiology of myocarditis associated with COVID-19 infection.
- The long-term arrhythmic risk and outcomes in patients who have recovered from COVID-19, including COVID-19 myocarditis are also addressed in this statement.
- Autonomic Dysfunction, defined as “altered autonomic function that adversely affects health,” after SARS-CoV-2 infection is well described and can result in severe symptoms. Post acute sequelae of SAR-CoV-2 (PASC) refers to the persistent symptoms experienced by some patients after COVID-19 infection and may include fatigue, dyspnea, palpitations and cognitive dysfunction, depending on the strain caused by the infection.
- Sudden cardiac arrest, both out-of-hospital and in-hospital during the pandemic, is addressed in this statement.
- This scientific statement reviews the available evidence on the epidemiology, pathophysiology, and autonomic dysfunction caused by the infection, as well as the clinical presentation, and management of cardiac arrhythmias in patients infected with and recovering from COVID-19.
Citation
Gopinathannair R, Olshansky B, Chung MK, Gordon S, Joglar JA, Marcus GM, Mar PL, Russo AM, Srivatsa UN, Wan EY; on behalf of the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology; Council on Basic Cardiovascular Sciences; Council on Cardiovascular and Stroke Nursing; Council on Genomic and Precision Medicine; and Council on Hypertension. Cardiac arrhythmias and autonomic dysfunction associated with COVID-19: a scientific statement from the American Heart Association. Circulation. Published online November 14, 2024. doi: 10.1161/CIR.0000000000001290