Cardiac arrhythmias in COVID-19 patients*

A.S.J.M. te Riele,1 C.A. Remme2

1 Department of Cardiology, Division of Heart & Lungs, University Medical Center Utrecht, Utrecht, The Netherlands; 2 Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam UMC, Location Academic Medical Center, Amsterdam, The Netherlands 

*Weergave van bespreking tijdens Journal Club meeting van de afdelingen cardiologie van Amsterdam UMC en OLVG d.d. 7 april 2020 

Initial retrospective studies from China have reported arrhythmias in 6-60% of COVID-19 patients, with an apparent overrepresentation in those with severe disease and signs of cardiac injury.1,2,3

Factors contributing to arrhythmogenesis in COVID-19 include systemic inflammation, coagulopathy, hypoxia, and myocardial ischemia/infarction. The virus may also directly affect the myocardium through ACE2 receptors, inducing cardiomyocyte dysfunction, apoptosis and possibly myocarditis.

COVID-19 therapeutics such as hydroxychloroquine, azithromycin and lopinavir/ritonavir may cause QTc prolongation and increase arrhythmic risk, particularly when used in combination and in the presence of electrolyte disturbances. Patients with inherited arrhythmia disorders may furthermore be at increased arrhythmia risk secondary to fever and COVID-19 therapeutics.4


  1. Guo TFan YChen M, et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol.2020 Mar 27. doi: 10.1001/jamacardio.2020.1017. [Epub ahead of print].
  2. Wang DHu BHu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. 2020 Feb 7. doi: 10.1001/jama.2020.1585. [Epub ahead of print].
  3. Du YTu LZhu P, et al. Clinical Features of 85 Fatal Cases of COVID-19 from Wuhan: A Retrospective Observational Study. Am J Respir Crit Care Med.2020 Apr 3. doi: 10.1164/rccm.202003-0543OC. [Epub ahead of print].
  4. Wu CIPostema PGArbelo E, et al. SARS-CoV-2, COVID-19 and inherited arrhythmia syndromes. Heart Rhythm.2020 Mar 31. pii: S1547-5271(20)30285-X. doi: 10.1016/j.hrthm.2020.03.024. [Epub ahead of print]

Figure 1. Cardiac arrhythmias in COVID-19 related arrhythmias: