When COVID Meets Arrhythmia

当 COVID-19遇见心律失常

So far there is no evidence suggesting an increased incidence of cardiac arrhythmia specifically associated with Covid-19 infection. However, in patients with either Covid-19- related fulminant myocarditis or ARDS, both ventricular and atrial arrhythmias have been reported. Most likely this was a consequence of acute myocardial injury, severe hypoxemia, and cytokine storm. Other factors that contribute to arrhythmias in Covid-19 patients include psychological factors, pre-existing cardiovascular disease, and side effect of therapeutic drugs

目前为止，尚无证据表明 COVID-19感染增加心律失常的发病率。然而，在COVID-19相关暴发性心肌炎或急性呼吸窘迫综合征的患者中，室性和房性心律失常的病例都有报道。这很可能是由急性心肌损伤、严重低氧血症和细胞因子风暴所导致的。此外，其他导致 COVID-19患者心律失常的因素还包括心理因素、既往心血管病史和治疗药物的副作用。

Sinus tachycardia is the most common arrhythmia in Covid-19 patients. At the acute stage, sinus tachycardia may reflect systemic hyper-sympathetic tone. Of note, sinus tachycardia can be sustained even months after patients become stable and free from hypoxemia, anemia, etc. It is unknown whether the sinus tachycardia during the recovery phase following Covid-19 infections is a long-term physiological response to Covid-19 infection itself or is a manifestation of autonomic dysfunction caused by the virus.

窦性心动过速是 COVID-19患者最常见的心律失常。在急性期，窦性心动过速可能提示全身交感神经处于兴奋状态。值得注意的是，患者在病情稳定且无低氧血症或贫血等情况下，窦性心动过速仍能持续数月。目前尚未明确 COVID-19感染后恢复期的窦性心动过速是 COVID-19感染的长期生理反应，还是由病毒所致的自主神经功能障碍。

Several medications have been recommended for compassionate use in patients with severe Covid-19 infection without thorough safety evaluation. Specifically, the combination of hydroxychloroquine or chloroquine with azithromycin should be used with caution. Both drugs are classified as QT-prolonging medications. Simultaneous administration of these two drugs could put patients at very high risk of QT prolongation and Tdp.

目前有几种药物被推荐用于重症 COVID-19感染的患者，但尚未进行彻底的安全性评估。尤其联合应用羟氯喹/氯喹与阿奇霉素应慎之又慎。这两种药物都属于可引起 QT 间期延长的药物。同时应用这两种药物可能使患者面临极高的 QT 间期延长和发生尖端扭转型室速（Tdp）的风险。

In rare situations, patients not infected with Covid-19 who developed life-threatening arrhythmias such as VT/VF storm or complete heart block will need emergency invasive procedures during the pandemic. Limited experience has shown that both catheter ablation and device implantation can be performed safely with proper personal protection equipment. A more widespread impact of Covid-19 on arrhythmia patients may be the delay in provision of care for elective procedures. While it is very likely that ablation for conditions such as SVT and AF may be safely deferred for many months, delay in performing other procedures (e.g. implantation of primary prevention ICDs) may confer some risks to patients.

少数情况下，在 COVID-19大流行期间，未感染 COVID-19的患者如出现致死性心律失常，如室速/室颤电风暴或完全性传导阻滞，将需要进行紧急侵入性治疗。目前有限的经验表明，使用适当的个人防护设备（PPE）可以安全地进行导管消融和器械植入。COVID-19对心律失常患者更大的影响可能是因流行病而推迟择期手术。尽管一些消融手术比如阵发性室上速和房颤可安全地推迟数月，但推迟其他一些手术(如植入 ICD 进行一级预防)可能会给患者带来一定的风险。