Mechanisms of Arrhythmia Development in COVID-19 Patients

Arrhythmia is a common cardiovascular complication in patients with the coronavirus disease 2019 (COVID-19). According to studies, the incidence of arrhythmia ranges from 16.7% to 19.6% among those hospitalized with COVID-19. The aim of this review is to study the mechanisms of arrhythmia occurrence in COVID-19 patients, to provide physicians with a comprehensive basis for the prevention and treatment of these arrhythmias. Materials and methods. A search was conducted for articles over the past 5 years in the PubMed, Google Scholar, and eLIBRARY databases by keywords in Russian and English, articles were selected in accordance with the purpose of the study. Results. The occurrence of arrhythmias in patients with COVID-19 may be associated with local and systemic inflammatory reactions caused by a viral infection, leading to damage to cardiomyocytes, pericarditis, impaired immune response, cytokine storms, structural changes in the heart and cardiac conduction disturbances, which ultimately leads to the development of arrhythmias. But there are also other factors: electrolyte imbalance, myocardial ischemia/hypoxia, proarrhythmic side effects of drugs used to treat COVID-19, dysfunction of the autonomic nervous system. Conclusion. Each of the described mechanisms of arrhythmia development influences other mechanisms, the greatest number of influences are: myocarditis and impaired regulation of the immune response. To prevent arrhythmias associated with COVID-19, it is necessary to monitor the underlying disease, provide early detection and treatment of myocardial damage and other organ dysfunctions, prevent hypoxia, prevent systemic inflammation and reduce the use of drugs that prolong the QT interval.