March24, 2023

Abstract Volume: 4 Issue: 4 ISSN:

Covid-19 Pandemic and Cardiac Arrhythmia

Dr M Belhameche*

Corresponding Author: Dr M Belhameche, GHEF Marne le vallée Rhythmology Unit.

Copy Right: © 2022 Dr M Belhameche, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received Date: May 28, 2022

Published Date: June 10, 2022

Covid-19 Pandemic and Cardiac Arrhythmia


The Covid -19 pandemic, has affected the whole world.

The clinic manifestations are primarily respiratory with an acute respiratory distress syndrome (ARDS).

But this virus can affect different organs including the heart with rhythmic complications.

Epidemiology: (54)
This pandemic has affected more than 500 million people worldwide. And was responsible for the deaths of more than 6 million.

Incidence of cardiac arrhythmia (2,3,8,32)

• The incidence of rhythm and conduction disorders during Covid-19 infection is estimated at 17% ( 11% if it's the Omicron virus)  of hospitalized patients. It is 44% of patients hospitalized in intensive care unit (ICU) .

• Atrial fibrillation represents the most frequent arrhythmia with more than 50% depending on the series (40 to 70%). After these are ventricular arrhythmia with an average frequency of 15%,  and in the third  conductive disorders.

Number of events according intensive care unit (ICU) hospitalization or non (ICU):


Arrhythmias are very frequent hospitalization in intensive care, testifying to the seriousness of their existence during this condition. Here is a study byAssociation of intensive care unit (ICU) status and cardiac arrhythmias. The odds ratios (and 95% confidence intervals) of ICU admission and specified cardiac arrhythmias are depicted. The dashed vertical red line represents an odds ratio 5 1. Unadjusted models have a blue marker. Multivariable models (black marker) were adjusted for age, sex, race, body mass index, heart failure, coronary heart disease, diabetes, hypertension, chronic kidney disease, and hydroxychloroquine treatment. NSVT 5 non sustained ventricular tachycardia.

Prognosis of cardiac arrhythmia in patient with covid-19:

The prognosis is poor if an arrhythmia is associated with covid-19. these arrhythmias are a marker of the severity of the viral attack linked to several mechanisms.

  • According to the series, mortality can reach 80%, especially in ICU patients.
  • Direct attack by the virus (myocarditis or pericarditis).

Indirect harm :

  • Severe hypoxemia (ARDS).
  • Severe inflammatory reaction(cytokine storm).

Hydroelectrtolytic disorder and or medications.

Risk of death according to age in Covid-19:(21,40,41,44).
The mortality rate is higher in the age group between 50 and 70 years. It is between 16% (16 patients out of 102) in the age group 50 to 60 years and 26% (23 patients out of 89) in the age group between 60 and 70 years.

Evolution of the disease after infection with the virus and Cardiac arrhythmia mecanisme. (15,18)

Once infected by the virus, there are 3 evolutionary phases in the mechanism of the appearance of complications, in particular cardiac arrhythmias.

1. phase of contact with the virus of 5 days.

2. Phase of onset of respiratory disorders with 5-day hypoxemia.
3. Inflammatory phase with cytokine storm with multi-organ damage lasting 5 days.

Inflammatory mechanism ( cytokine storm):(9,10,12,13,14,18,21,26,32,39).

There are two mechanisms

  • A direct mechanism or direct attack by the pulmonary and myocardial virus (fibroblast and myocytes).

An indirect inflammatory mechanism through cytokines. This inflammation can trigger a cytokine storm with hepatic and central nervous system damage as described in this table.

Electrocardiographic aspects:(15,16,36,37,46,47)

Sinus dysfunction (bradycardia).

Sinus tachycardia.

Supra ventricular tachycardia.

Atrial fibrillation or atrial flutter.

Ventricular premature complexes and nonsustained VT.

Conduction disturbances (AVB/BBB).

Polymorphic ventricular tachycardia (torsade de pointe).

Unstable ventricular tachycardia or ventricular fibrillation.

Management of arrhythmias: (16,18,19,20)

The management of cardiac arrhythmias linked to covid 19 is no different from those in patients without covid. There are, however, a few additional means to consider:

   - Treatment of hypoxemia.

   - Treatment of fever.

   - Treatment of electrolyte disorders related to vomiting and diarrhea.

   - Consider antibiotic treatment responsible for QT prolongation.

   - Specific considerations for management cardiac arrhythmia :

  • Rate control for management minimise the risck of QTc prolongation.
  • Implantation temporary pace maker for bradycardie or atrioventricular block.
  • External electric shock sometimes ciculatory assitance (ECMO) to better oxygenate the patient and put the heart at rest.
  • The medical treatment  is the same as for non-Covid.


  • Heart rhythm disorders are common in infection with the covid 19 virus.
  • There mechanism is multifactorial.
  • Their prognosis is poor with a high mortality rate testifying to the seriousness of the infection.
  • Their management is the same apart from a few considerations.


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