Table 1.
Summary of studies of patients with tachyarrhythmia
| Study | Age (yr) | No. | Arrhythmia | Condition related to SARS-CoV-2 | Underlying disease | Clinical detail | Management (for antiarrhythmiaa)+COVID-19 treatment) | Outcome | Study type | Country |
|---|---|---|---|---|---|---|---|---|---|---|
| Samuel et al. [54] 2020 November | Median age, 14.5 yr (range, 12-20 yr) | 6/36 (17%) | Nonsustained monomorphic VT (n=5), sus- tained AT (n= 1) | Acute COVID-19 (6), acute myocarditis (2) | No previous heart disease | LV dysfunction (2), large pericardial effusion (1), normal LV function (4) | All hemodynamically tolerated and sefl-lmit- ed arrhythmia.prophy- lactic antiarrhythmic drug; amiodarone (1), beta-blocker (2). Hy- droxychloroquine±azi- thromycin | Self-resolving, no mortality | Observation study | New York, USA |
| Cantarutti et al. [65] 2021 August | Total cohort mean, 9±5.9 | 3/294 (1%) | Nonsustained VT (2), AF (1) | Acute COVID-19 (248), MIS-C (46) | NA | NA | Not requiring emer- gency treatment for arrhythmia. IVIG, cor- ticosteriod, anakinra in most severe pa- teints. | All patients recovered. | Multicenter observation study | Rome, Italy |
| Dionne et al. [55] 2022 | Median, 15.4 yr (range, 10.4–17.4 yr) | 63/3,600 (1.8%) | SVT (28, 44%): reentrant SVT (2), ectopic AT (10), AFL (8), AF (9), accelerated junctional rhy- thm (9, 14%), VT (38, 60%) | Acute COVID-19 (22/1257,1,8%), MIS-C (41/ 2343, 1.7%) | More patients with underlying heart disease in acute COVID-19 | Severe LV dysfunction (31%), more respiratory support (81%), more vaso- pressor requirement and ECMO | No intervention (41%), Antiarrhythmic medi- cation (49%), electri- cal cardioversion (17 %), CPR (13%), ECMO (14%) | 9/63 (14%) died. 22% were discarged with medication. | Multicenter | USA, multicenter |
| Tseng et al. [79] 2021 March | 5 | 1 | Monomorphic VT | Acute COVID-19, fulminant myocarditis | Previously healthy | Cardiogenic shock, biventricular dysfunction | Cardioversion, lidoca- ine, amiodarone → no effect, VA ECMO on HD 4 | Complete reco- very and discharged | Case report | Michgan, USA |
| Kohli et al. [80] 2022 | 15 | 1 | AF | Acute COVID-19, fulminant myocarditis | Previously healthy | Severe LV dysfunction, cardiogenic shock → milrinone, epinephrine, AF on HD2 | Initropics, IVIG, steriod, anakinra, cardiover- sion followed by amio- darone for AF → no recur | NSR, normaliz- ed LV function, no recur, discharged | Case report | Chicago, USA |
| Hopkins and Webster [81] 2021 April | 9 Days, newborn | 1 | SVT | Acute COVID-19 | Normal heart. mother had acute COVID-19 | Orthodromic SVT with aberrancy. Normal LV function | Transesophageal over- drive pacing, oral pro- pranolol 2 mg/kg/day | No recur of SVT, discharged | Case report | Chicago, USA |
| Whittaker et al. [9] 2020 June | NA | 4/58 (6.9%) | Broad complex tachycardia (n=1), AF (n=1), second-degree AVB (n= 1), and first-degree AVB (n=1) | MIS-C | Most were previously healthy (88%) | (1) A patient with wide complex ta- chycardia → low cardiac output- → ECMO, (2) a patient with AF → amiodarone, (3) a patient with 2nd degree AVB NSR | For the total cohort: inotropics in 47%, IVIG in 71%, steroid in 64 %, Anakinra in 5%, and infliximab in 14%, supportive care alone in 22% | NA | Multicenter observation study | England |
| Riollano‐Cruz et al. [82] 2020 June | 14 | 1/15 (6.7%) | VT, QT prolongation | MIS-C | NA | Mild LV dysfunction 48% | Inotropics, amiodarone (not specified for the management of arrhythmia), lidocaine, anakinra, tocilizumab, remdesivir | Recovered LV function, discharged on HD 13 | Obsrvasion study | New York, USA |
| Clark et al. [44] 2020 September | Total cohort mean 7±5.2 | 6/55 (11%) | cAVB (n=3), transient 2nd AVB, sinus pause, 1 st degree AVB, and VT (1) | MIS-C | Previously healthy | All had decreased LV EF (27%–55%) | IVIG, steroid. Not specified for the antiarrhythmic therapy | cAVB normalized within 2 weeks. Other arrhtyhmia out come is not described | Multicenter observation study | International (USA, UK, spain, pakistan) |
| Santi et al. [83] 2020 October | 17 | 1 | AF, nonsustained VT | MIS-C | Previously healthy | Hypotensive → normal saline and epinephrine. Normal heart function, no pulmonary hypertension | AF on HD 3 → DC cardioversion, recurrence of AF → cardioversion and amiodarone, anakinra, IVIG, methylPd | Recovery, discharged home on HD 16 | Case report | Califonia, USA |
| Regan et al. [58] 2021 | 6 | 2/63 (3.2%) | Nonsustained ectopic AT | MIS-C | NA | Asymptomatic | No treatment | Live | Observation study | London, UK |
| 14 | Ectopic AT with RBBB | MIS-C | NA | Cardiogenic shock → ECMO | ECMO support and rate control with amiodarone → died following complications from the ECMO support | Died following complications from the ECMO support | ||||
| Tomlinson et al. [84] 2021 March | 13 | 1 | Accelerated idioventricular rhythm, sinus node dysfunction | MIS-C | Previously healthy | Normal LV EF, hypotension → epinephrine. Sinus node dysfunction, idioventricular rhythym → HD2, sinus ta- chycardia with left axis deviation | No antiarrhythmic drug. IVIG | Normal sinus rhythm on discharge, HD 9 | Case report | Virginia, USA |
| Schneider et al. [85] 2022 | 6 | 1 | VT | MIS-C | Previously healthy | LV dysfunction, cardiogenic shock, brief cardiac arrest VT → VA ECMO | VA ECMO, IVIG, steroid, tosilizumab, and remdesivir | Complete recovery and discharged | Case series | Michgan, USA |
| 15 | 1 | VT | MIS-C | TIDM | Severe both ventricular dysfunction → cardiogenic shock and development of VT | VA ECMO, IVIG, steroid, infliximab, and remdesivir | Decanulated after 4 days of ECMO. Discharged | |||
| Simpson et al. [57] 2020 July | 18 Years | 1 | VT | Acute COVID-19 | HCM, obesity, TIIDM, HTN | Preserved biventricular function→ VVECMO d/t respiratory failure→ escalated to VA ECMO d/t acute decompensated→ HF→VT→ stabilizaed after management | Defibrillation, infusion of amiodarone and lidocaine. Hydroxychloroquine, azithromycin, tocilizumab, convalescent plasma, IVIG, methylPd | Death d/t recurrence of VT on HD 31 | Case series | Multicenter, USA |
| 6 Months | 1 | VT | Acute COVID-19 | Repaired ALCAPA with severe ven- tricular dysfunction | New severe PHT with RV dysfunction, LV EF 20%. During intubation, bradycardia and VT → epinephrine, CPR | Not specified. epinephrine, milrinone, iNO for PHT, tocilizumab, remdesivir | Dischargedhome on HD 35 | Case series | Multicenter, USA |
SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; COVID-19, coronavirus disease 2019; LV, left ventricular; VT, ventricular tachycardia; AF, atrial fibrillation; MIS-C, multisystem inflammatory syndrome in children; NA, not available; IVIG, intravenous immunoglobulin; SVT, supraventricular tachycardia; AT, atrial tachycardia; AFL, atrial flutter; CPR, cardiopulmonary resuscitation; ECMO, extracorporeal membrane oxygenation; VA, venoarterial; HD, hospital day; NSR, normal sinus rhythm; AVB, atrioventricular block; cAVB, complete atrioventricular block; RBBB, right bundle branch block; EF, ejection fraction; VV, venovenous; HCM, hypertrophic cardiomyopathy; TIDM, type I diabetes mellitus; TIIDM, type II diabetes mellitus; HF, heart failure; d/t, due to; HTN, hypertension; ALCAPA, anomalous left coronary artery from the pulmonary artery; PHT, pulmonary hypertension; RV, right ventricular; iNO, inhaled nitric oxide.
a)
Arrhythmia management is underlined.
b)
Four patients had underlying extracardiac disease: sickle cell disease (n=1), hematologic malignancy (n=2), Bloom syndrome (n=1)