Increased risk of arrhythmia in COVID-19 patients: Possible roles of both the disease pathophysiology and adverse drug reactions

Abstract

Dear Editor, Coronavirus disease 2019 (COVID-19) is a newly emerging and highly contagious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS- CoV‑2) that was first reported in December 2019 and was announced as a pandemic disease on March 11, according to the World Health Organization warning.[1] The clinical sign and symptoms of COVID-19 mostly include fever (98.6%), fatigue (69.6%), dry cough (59.4%), anorexia (39.9%), myalgia (34.8%), and dyspnea (31.2%), and it causes the most involvement in lung tissue.[2] However, in addition to lung involvement, other organs can also be involved in COVID-19, including the heart, and causes complications such as acute cardiac injury and arrhythmia (which reported in 44.4% of intensive care unit [ICU] patients and 6.9% of non-ICU patients).[2,3] Major mechanisms that predispose COVID-19 patients to arrhythmia include the direct effect of the SARS‑CoV‑2 on the heart and lung tissue (causing hypoxia and has an indirect effect), diarrhea and electrolyte disturbances (especially hypokalemia), cytokine storm, and interleukin (IL)‑6 effects on sympathetic tone, cardiomyocyte ion channels (hERG-K+), and fever (causing Brugada syndrome