Stroke, Dementia, and Atrial Fibrillation: From Pathophysiologic Association to Pharmacological Implications

Russo, Vincenzo; Vio, Riccardo; Proietti, Riccardo

doi:10.3390/medicina56050227

Cited by 11 publications

(11 citation statements)

References 21 publications

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“…According to current guidelines [86] anticoagulation is recommended in AF patients with CHA2DS2-VASc score of 2 or more (3 or more in women) and should be considered in those with CHA2DS2-VASc score of 1 or more (2ormoreinwomen). Since hospitalized COVID-19 patients are usually older than 65 years and present in approximately 70% of cases with two or more comorbidities, most of AF patients require long-term anticoagulation [87] . Hemodynamically stable, hospitalized COVID-19 patients with AF may be treated with either unfractionated heparin, low molecular weight heparin (LMWH) or direct oral anticoagulants (DOACs), depending on the possibility of oral treatment, renal function and other clinical conditions.…”

Section: Thromboprophylaxismentioning

confidence: 99%

COVID-19 associated atrial fibrillation: Incidence, putative mechanisms and potential clinical implications

Gawałko

Kapłon‐Cieślicka

Hohl

et al. 2020

IJC Heart & Vasculature

134

142

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Coronavirus disease 2019 (COVID-19) is a novel, highly transmittable and severe strain disease, which has rapidly spread worldwide. Despite epidemiological evidence linking COVID-19 with cardiovascular diseases, little is known about whether and how COVID-19 influences atrial fibrillation (AF), the most prevalent arrhythmia in clinical practice. Here, we review the available evidence for prevalence and incidence of AF in patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and discuss disease management approaches and potential treatment options for COVID-19 infected AF patients.

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Section: Thromboprophylaxismentioning

confidence: 99%

COVID-19 associated atrial fibrillation: Incidence, putative mechanisms and potential clinical implications

Gawałko

Kapłon‐Cieślicka

Hohl

et al. 2020

IJC Heart & Vasculature

134

142

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“…According to a recent survey of electrophysiology professionals, atrial fibrillation (AF) was the most commonly encountered cardiac arrhythmia observed in patients with COVID-19 infection [13] . Several mechanisms could be involved in the pathogenesis of AF in these patients; virus-induced cardiac injury that could lead to perimyocarditis, hypoxemia frequently occurring in these patients, systemic infection, common occurrence of the COVID-19 infection in older patients who are already susceptible to AF, and sympathetic nervous system overactivity could all account for such a high incidence of this arrhythmia in this particular population [ 13 , 21 ].…”

Section: Atrial Fibrillationmentioning

confidence: 99%

COVID-19 infection and cardiac arrhythmias

Manolis¹,

Manolis

et al. 2020

Trends in Cardiovascular Medicine

112

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Highlights Serious cardiac arrhythmias may be the consequence of direct effects of COVID-19 infection, but also the outcome of the deleterious effects of systemic illness and the adverse proarrhythmic reactions to drugs employed in the treatment of this pandemic Drug combinations, especially of QT-prolonging agents, can lead to higher arrhythmogenicity, compared with single drug therapies Furthermore, critically ill COVID-19 patients often have comorbidities that can trigger life-threatening ventricular arrhythmias, while acute myocardial injury increases the prevalence of arrhythmias ECG and QTc monitoring and taking appropriate measures are of critical importance to prevent, detect and manage cardiac arrhythmias in COVID-19 patients Contactless monitoring and telemetry for inpatients, especially those admitted to the ICU, as well as for outpatients needing continued management, has recently been facilitated by implementing digital health monitoring tools

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“…The pharmacological treatments currently administered in patients with COVID‐19 include antiviral agents, as Lopinavir/Ritonavir (LPN/RTN), and drugs with immune‐modulatory and/or anti‐inflammatory properties, as hydroxychloroquine (HQ) and azithromycin (AZT), which are currently off-label used in Chinese and Italian centers ( Dong et al, 2020 ; Russo et al, 2020a ). LPN/RTN causes the dose-dependent block of both human ether-a-go-go-related gene (HERG) potassium channels and delayed rectifier potassium current (IKr) channels predisposing to QT prolongation and torsade de pointes (TdP) ( Anson et al, 2005 ; Russo et al, 2020b ). Increased corrected QTc interval (QTc) has been reported in hospitalized COVID-19 patients treated with HQ/AZT ( Bun et al, 2020 ; Chorin et al, 2020 ; Cipriani et al, 2020 ; Hor et al, 2020 ; Mercuro et al, 2020 ; Ramireddy et al, 2020 ) alone or in combination, due the inhibitory effects on IKr channels.…”

Section: Introductionmentioning

confidence: 99%

Effect of Triple Combination Therapy With Lopinavir-Ritonavir, Azithromycin, and Hydroxychloroquine on QT Interval and Arrhythmic Risk in Hospitalized COVID-19 Patients

et al. 2020

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Introduction No data are provided about the effect of triple combination therapy with Lopinavir/Ritonavir (LPN/RTN), hydroxychloroquine (HQ) and azithromycin (AZT) on corrected QT (QTc) interval and arrhythmic risk, in COVID-19 patients. This study aims to describe the incidence of extreme QTc interval prolongation among COVID-19 patients on this experimental treatment and to identify the clinical features associated with extreme QTc prolongation. Materials and Methods Data of 87 COVID-19 patients, treated with triple combination including LPN/RTN, HQ and AZT, were analyzed. QT interval was obtained by the tangent method and corrected for heart rate using Bazett’s formula. Extreme QTc interval prolongation was considered an absolute QTc interval ≥ 500 ms or an increase in QTc intervals of 60 ms or greater (ΔQTc ≥ 60 ms) compared with baseline. Results Hypertension (66.7%) and diabetes (25.3%) were the most prevalent cardiovascular comorbidities. Twenty patients (23%) showed extreme QTc interval prolongation; no clinical, electrocardiographic or pharmacological characteristics have been associated to extreme QTc prolongation, except the history of ischemic stroke ( P= 0,007 ). One torsade de pointes (TdP) in patient with QTc extreme prolongation (QTc: 560 ms) after 5 days of therapy was recorded. Conclusions We observed a high incidence of extreme QTc interval prolongation among COVID-19 patients on triple combination therapy. Since the incidence of malignant arrhythmias seems to be not negligible, a careful electrocardiographic monitoring would be advisable.

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Stroke, Dementia, and Atrial Fibrillation: From Pathophysiologic Association to Pharmacological Implications

Abstract: The impact of stroke and dementia on disability and death is a major contemporary health issue [...]

Cited by 11 publications

References 21 publications

COVID-19 associated atrial fibrillation: Incidence, putative mechanisms and potential clinical implications

COVID-19 associated atrial fibrillation: Incidence, putative mechanisms and potential clinical implications

COVID-19 infection and cardiac arrhythmias

Effect of Triple Combination Therapy With Lopinavir-Ritonavir, Azithromycin, and Hydroxychloroquine on QT Interval and Arrhythmic Risk in Hospitalized COVID-19 Patients

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