Sinus Bradycardia and QT Interval Prolongation in West Nile Virus Encephalitis: A Case Report

Abstract

Cardiac arrhythmias were reported in cases of West Nile Virus (WNV) encephalitis; however, the underlying pathophysiology remains incompletely understood. We present a 67-year-old male with altered mental status, later diagnosed with WNV encephalitis. Hospital course was complicated by progressive sinus bradycardia and corrected QT (QTc) prolongation. These findings persisted despite the absence of classical causes and resolved only after improvement of the underlying encephalitis. After excluding classical causes, autonomic dysfunction is one of the proposed mechanisms behind cardiac arrhythmias in WNV encephalitis. Resolution of arrhythmias is expected after the improvement of underlying encephalitis and should be taken into consideration before proceeding for pacemaker placement or other cardiac intervention. Furthermore, this case highlights the importance of continuous cardiac monitoring in WNV encephalitis patients.

Cardiac Corrected QT Interval Changes Among Patients Treated for COVID-19 Infection During the Early Phase of the Pandemic

“…Other viruses have also been associated with QTc prolongation, including HIV, 13 HCV coinfection, 14 and West Nile virus. 15 HIV-associated inflammation, specifically elevated IL-6 level, is further independently associated with QT prolongation 23 and prolonged repolarization represented as T wave onset-to-peak duration. 24 Infection with SARS-CoV-2 may result in cardiac enzyme release, which parallels the systemic inflammatory response marked by elevation of ferritin, LDH, CRP, and IL-6.…”

“… 12 Specific viruses are also associated with QTc prolongation. 13 , 14 , 15 Few analyses have compared QTc intervals between patients with and without COVID-19, an inflammatory viral condition. The present study used multivariable models to investigate which clinical characteristics were associated with prolonged QTc from baseline in patients with COVID-19 and to isolate the independent association of COVID-19 infection with QTc.…”

“…Systemic inflammation prolongs QTc via cytokine-mediated effects on potassium channel expression . Specific viruses are also associated with QTc prolongation . Few analyses have compared QTc intervals between patients with and without COVID-19, an inflammatory viral condition.…”

Cardiovascular sequalae in uncomplicated COVID-19 survivors

“…The strikingly high prevalence of sinus bradycardia amongst COVID-19 survivors in the present study, contrasts with other respiratory viral infections such as influenza. Profound sinus bradycardia or sinus asystole leading to syncope have only been rarely reported in other viral infections including influenza [23], herpes simplex virus [24,25], Ebola and West Nile virus [26,27], attributed to acute myocarditis or autonomic nervous system involvement. In the outbreak of SARS due to SARS-CoV in 2003, studies from Canada and Hong Kong have also reported high prevalence of sinus bradycardia in hospitalized SARS patients as high as 27.5% [28,29].…”

QTc prolongation during antiviral therapy in two COVID‐19 patients

“…As we know, some viruses (eg human immunodeficiency virus, hepatitis C virus and West Nile virus) are associated with QTc interval prolongation 14‐16 . However, the relationship between QTc prolongation and SAR‐CoV‐2 infection remains uncertain.…”