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Ai MY, Chang WL, Yang CJ. Remdesivir-Induced Bradycardia and Mortality in SARS-CoV-2 Infection, Potential Risk Factors Assessment: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:7518. [PMID: 38137586 PMCID: PMC10743390 DOI: 10.3390/jcm12247518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/19/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
Background: The efficacy of remdesivir in reducing disease severity among COVID-19-infected patients has been established, but concerns have emerged regarding the potential side effects of bradycardia. The aim of this study was to investigate the association between remdesivir-induced bradycardia and mortality, while also identifying the related risk factors. Materials and methods: The PubMed/Medline, Cochrane Central and ClinicalTrials.gov databases were searched. Randomized controlled trials and prospective or retrospective cohort studies were included (through 14 July 2023). The random-effects model was implemented using Comprehensive Meta-Analysis software version 3.0 to examine the outcomes. Results: A total of 12 prospective or retrospective studies involving 7674 patients were analyzed. The primary outcomes revealed a significant association between remdesivir administration and bradycardia development (Odds ratio = 2.556, 95% CI = 2.049-3.188, p < 0.001). However, no statistically significant increase in the mortality rate was observed among patients with bradycardia during remdesivir treatment (Odds ratio = 0.872, 95% CI = 0.483-1.576, p = 0.651). The secondary outcome demonstrated a significant association between chronic kidney disease (CKD) and remdesivir-induced bradycardia (OR: 1.251, 95% CI: 1.003-1.561, p = 0.047). Moreover, patients with obesity (OR = 1.347, 95% CI = 1.098-1.652, p = 0.004) were more likely to experience remdesivir-induced bradycardia. Conclusions: Although a higher risk of bradycardia occurred during remdesivir treatment, the occurrence of remdesivir-induced bradycardia did not lead to higher mortality. Our study also identified patients with obesity and CKD as high-risk subgroups for experiencing bradycardia during remdesivir treatment.
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Affiliation(s)
- Ming-Ying Ai
- Department of Pharmacy, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan; (M.-Y.A.); (W.-L.C.)
| | - Wei-Lun Chang
- Department of Pharmacy, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan; (M.-Y.A.); (W.-L.C.)
| | - Chia-Jui Yang
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11217, Taiwan
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2
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Chen YZ, Lin MS, Lin YP, Liu YZ, Yang CJ. Precipitating factors of bradycardia after remdesivir administration: ICU admission and cutoff value for declining heart rate. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:970-976. [PMID: 37407291 PMCID: PMC10290731 DOI: 10.1016/j.jmii.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/08/2023] [Accepted: 06/15/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Despite increasing concerns about the association between remdesivir and bradycardia in severe coronavirus disease 2019 (COVID-19) patients receiving remdesivir, information on its clinical course and precipitating factors is limited. Our aim was to investigate possible triggers of bradycardia after remdesivir administration. METHODS We retrieved the medical records of hospitalized severe and critical COVID-19 patients who received remdesivir from May 1, 2021 to June 30, 2021. Bradycardia was defined as two episodes of a heart rate (HR) < 60 bpm in 24 h. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the discriminability of heart rate pattern on the occurrence of bradycardia. The precipitating factors of bradycardia were examined by a logistic regression model. RESULTS Regardless of bradycardia status, the median heart rate dropped during remdesivir treatment (from 85 to 72 bpm, p < 0.001), with the heart rate dropping considerably within the first two days of remdesivir treatment. Among various heart rate descriptors, HR ratiomin (d2-d1) had the best discrimination (AUC = 0.7336), and a reduction in HR ratiomin (d2-d1) by 14.65% was associated with bradycardia. Intensive care unit (ICU) admission was associated with an increased risk of bradycardia (odds ratio: 3.41; 95% CI: 1.12-10.41). CONCLUSIONS In severe COVID-19 patients receiving remdesivir, the risks of bradycardia were influenced by a substantial reduction in heart rate during the first two days of remdesivir treatment and ICU admission. These findings suggest that clinical practitioners should intensively monitor heart rates during remdesivir treatment.
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Affiliation(s)
- Yan-Zuo Chen
- Department of Pharmacy, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ming-Shen Lin
- Department of Pharmacy, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yi-Ping Lin
- Department of Pharmacy, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yi-Zhan Liu
- Department of Pharmacy, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chia-Jui Yang
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Ishisaka Y, Aikawa T, Malik A, Kampaktsis PN, Briasoulis A, Kuno T. Association of Remdesivir use with bradycardia: A systematic review and meta-analysis. J Med Virol 2023; 95:e29018. [PMID: 37539782 DOI: 10.1002/jmv.29018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/06/2023] [Accepted: 07/24/2023] [Indexed: 08/05/2023]
Abstract
Remdesivir has been used for coronavirus disease 2019 (COVID-19) pneumonia with oxygen requirements that do not require mechanical intubation, and several studies showed a reduction in disease duration. However, there is a concern about bradycardia as its side effect. We aimed to investigate the association between Remdesivir and bradycardia by integrating findings from prior studies. We queried PubMed and EMBASE in February 2023 and performed a meta-analysis of studies investigating bradycardia in patients who did or did not receive Remdesivir. The outcome of interest was the rate of bradycardia and in-hospital mortality. We identified eight studies involving 8993 patients, of which seven studies investigated bradycardia. Six studies were observational, one was a case-control, and one was a randomized trial. Incidence of bradycardia was 400/3480 patients (22.3%, 95% confidence interval, CI: [6.5-54.4], I2 = 99%) in the Remdesivir group and 294/5005 (9.8%, 95% CI: [2.8-29], I2 = 98.61) in the non-Remdesivir group. The odds ratio of bradycardia was 2.11 (95% CI: [1.65-2.71], I2 = 22%, p < 0.001) for the Remdesivir group. There was no difference in mortality between the two groups. Patients who received Remdesivir for COVID-19 were more likely to develop bradycardia. The effect of confounding factors should be considered to further clarify the possible association.
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Affiliation(s)
- Yoshiko Ishisaka
- Department of Medicine, Mount Sinai Beth Israel, New York City, New York, USA
| | - Tadao Aikawa
- Department of Cardiology, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Aaqib Malik
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Polydoros N Kampaktsis
- Division of Cardiology, Columbia University Irving Medical Center, New York City, New York, USA
| | - Alexandros Briasoulis
- Division of Cardiovascular Medicine, Section of Heart Failure and Transplantation, University of Iowa, Iowa City, Iowa, USA
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
- Division of Cardiology, Jacobi Medical Center, Albert Einstein College of Medicine, New York, USA
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Attena E, Caturano A, Annunziata A, Maraolo AE, De Rosa A, Fusco FM, Halasz G, Dall'Ospedale V, Conte M, Parisi V, Galiero R, Sasso FC, Fiorentino G, Russo V. Remdesivir treatment and clinical outcome in non-severe hospitalized COVID-19 patients: a propensity score matching multicenter Italian hospital experience. Eur J Clin Pharmacol 2023:10.1007/s00228-023-03499-z. [PMID: 37212843 DOI: 10.1007/s00228-023-03499-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/12/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Remdesivir exerts positive effects on clinical improvement, even though it seems not to affect mortality among COVID-19 patients; moreover, it was associated with the occurence of marked bradycardia. METHODS We retrospectively evaluated 989 consecutive patients with non-severe COVID-19 (SpO2 ≥ 94% on room air) admitted from October 2020 to July 2021 at five Italian hospitals. Propensity score matching allowed to obtain a comparable control group. Primary endpoints were bradycardia onset (heart rate < 50 bpm), acute respiratory distress syndrome (ARDS) in need of intubation and mortality. RESULTS A total of 200 patients (20.2%) received remdesivir, while 789 standard of care (79.8%). In the matched cohorts, severe ARDS in need of intubation was experienced by 70 patients (17.5%), significantly higher in the control group (68% vs. 31%; p < 0.0001). Conversely, bradycardia, experienced by 53 patients (12%), was significantly higher in the remdesivir subgroup (20% vs. 1.1%; p < 0.0001). During follow-up, all-cause mortality was 15% (N = 62), significantly higher in the control group (76% vs. 24%; log-rank p < 0.0001), as shown at the Kaplan-Meier (KM) analysis. KM furthermore showed a significantly higher risk of severe ARDS in need of intubation among controls (log-rank p < 0.001), while an increased risk of bradycardia onset in the remdesivir group (log-rank p < 0.001). Multivariable logistic regression showed a protective role of remdesivir for both ARDS in need of intubation (OR 0.50, 95%CI 0.29-0.85; p = 0.01) and mortality (OR 0.18, 95%CI 0.09-0.39; p < 0.0001). CONCLUSIONS Remdesivir treatment emerged as associated with reduced risk of severe acute respiratory distress syndrome in need of intubation and mortality. Remdesivir-induced bradycardia was not associated with worse outcome.
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Affiliation(s)
- Emilio Attena
- Cardiology Unit, Monaldi Hospital - A.O.R.N. Dei Colli, Naples, Italy
| | - Alfredo Caturano
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Anna Annunziata
- Sub-intensive Care Unit and Respiratory Pathophysiology Department, Cotugno Hospital - A.O.R.N. Dei Colli, Naples, Italy
| | - Alberto Enrico Maraolo
- First Division of Infectious Diseases, Cotugno Hospital - A.O.R.N. Dei Colli, Naples, Italy
| | - Annunziata De Rosa
- Respiratory Infectious Diseases Unit, Cotugno Hospital - A.O.R.N. Dei Colli, Naples, Italy
| | - Francesco Maria Fusco
- Third Division of Infectious Diseases, Cotugno Hospital - A.O.R.N. Dei Colli, Naples, Italy
| | - Geza Halasz
- Cardiology Department, Guglielmo Da Saliceto Hospital, Piacenza, Italy
| | | | - Maddalena Conte
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Valentina Parisi
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Raffaele Galiero
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giuseppe Fiorentino
- Sub-intensive Care Unit and Respiratory Pathophysiology Department, Cotugno Hospital - A.O.R.N. Dei Colli, Naples, Italy
| | - Vincenzo Russo
- Division of Cardiology, Department of Medical Translational Sciences, University of Campania Luigi Vanvitelli, Naples, Italy.
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5
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Landerholm A, Fedotova NO, Levy-Carrick NC, Chung R, Funk MC. C-L Case Conference: Torsades de Pointes in a Patient With Lifelong Medical Trauma, COVID-19, Remdesivir, Citalopram, Quetiapine, and Hemodialysis. J Acad Consult Liaison Psychiatry 2023; 64:147-157. [PMID: 36351521 DOI: 10.1016/j.jaclp.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/19/2022] [Accepted: 11/02/2022] [Indexed: 11/08/2022]
Abstract
We present a case of Torsades de Pointes (TdP) in a patient with COVID-19 infection and multiple TdP risk factors including QT-interval prolongation, hemodialysis, bradycardia, and treatment with remdesivir, citalopram, and quetiapine. The case was complicated by post-resuscitation anxiety superimposed on a history of medical trauma since childhood. Top experts in the field of consultation-liaison psychiatry, trauma informed care, and cardiac electrophysiology provide perspectives on this case with a review of the literature. Key teaching topics include identification of TdP risk factors in patients with a complex illness; the necessity for prompt electrophysiology consultation in clinical scenarios with high risk for TdP; and the approach to patients with medical trauma using a trauma-informed lens. We highlight the contributions of COVID-19, the pharmacokinetics of QT-interval-prolonging psychotropic medications, the risks of hemodialysis, and the role of remdesivir-induced bradycardia in this first reported case of TdP in a patient treated with remdesivir.
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Affiliation(s)
- Angela Landerholm
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA; Department of Psychosocial Oncology, Dana Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA.
| | - Natalie O Fedotova
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Nomi C Levy-Carrick
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Roy Chung
- Department of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Section, Cleveland Clinic, Cleveland, OH
| | - Margo C Funk
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
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Filtz A, Carandina A, Fasiello A, Barbetta L, Lombardi R, Cinque F, Rizzi G, Ceriani E, Furlan L, Bellocchi C, Fracanzani AL, Hu C, Cogliati C, Canetta C, Peyvandi F, Montano N, Tobaldini E. Remdesivir-induced bradycardia in patients hospitalized with SARS-CoV2 infection: a possible vagally-mediated mechanism. Intern Emerg Med 2023; 18:359-366. [PMID: 36539604 PMCID: PMC9767799 DOI: 10.1007/s11739-022-03168-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
Recently, case series studies on patients with SARS-CoV-2 infection reported an association between remdesivir (RDV) administration and incidental bradycardia. However, the phenomenon has not yet been described in detail. We conducted a retrospective case-control study to evaluate the occurrence of RDV-related bradycardia in patients hospitalized for SARS-CoV2 pneumoniae. We retrospectively evaluated 71 patients, hospitalized in six internal medicine wards of the Milan area, affected by mild-to-moderate COVID-19 who received RDV (RDV group) and 54 controls, matched for sex, age and disease severity on admission (CTR group). The mean heart rate value recorded during the first two days of hospitalization was considered as baseline heart rate (HRb). Heart rate values relative to the 5-days treatment and the 5-days post-treatment were extracted for RDV group, while heart rate values relative to 10 days of hospitalization were considered for the CTR group. ΔHR values were calculated as maximum HR drop versus HRb. Possible associations between ΔHR and clinical-demographic factors were assessed through regression analysis. The RDV group experienced a significantly higher incidence of bradycardia compared to the CTR group (56% vs 33%, OR 2.6, 95% CI 1.2-5.4, p value = 0.011). Moreover, the RDV group showed higher ΔHR values than the CTR group. The HR progressively decreased with daily administration of RDV, reaching the maximun drop on day six (-8.6±1.9 bpm). In RDV group, patients who experienced bradycardia had higher drop in HR, higher alanine aminotransferase (ALT) values at the baseline (bALT) and during the RDV administration period. ΔHR was positively associated with HRb (β = 0.772, p < 0.001) and bALT (β = 0.245, p = 0.005). In conclusion, our results confirmed a significant association between RDV administration and development of bradycardia. This effect was proportional to baseline HR and was associated with higher levels of baseline ALT, suggesting a possible interaction between RDV liver metabolism and a vagally-mediated effect on HR due to increased availability of RDV metabolites.
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Affiliation(s)
- Annalisa Filtz
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelica Carandina
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Annalaura Fasiello
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Barbetta
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Rosa Lombardi
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Felice Cinque
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giulia Rizzi
- Department of Biomedical and Clinical Sciences, Internal Medicine, L. Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Elisa Ceriani
- Department of Biomedical and Clinical Sciences, Internal Medicine, L. Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Ludovico Furlan
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Bellocchi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Ludovica Fracanzani
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Cinzia Hu
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Cogliati
- Department of Biomedical and Clinical Sciences, Internal Medicine, L. Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Ciro Canetta
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Flora Peyvandi
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Nicola Montano
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Eleonora Tobaldini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
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Alsowaida YS, Shehadeh F, Kalligeros M, Mylonakis E. Incidence and potential risk factors for remdesivir-associated bradycardia in hospitalized patients with COVID-19: A retrospective cohort study. Front Pharmacol 2023; 14:1106044. [PMID: 36817161 PMCID: PMC9930471 DOI: 10.3389/fphar.2023.1106044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
Background: Remdesivir is widely used for the management of COVID-19 and several studies have reported bradycardia as a potential side effect associated with this agent. The aim of the present study was to evaluate the incidence rate, severity, and potential risk factors of remdesivir-associated bradycardia. Methods: We performed a retrospective cohort study among hospitalized adult patients with COVID-19 who were treated with remdesivir from March 2020 to October 2021. Our primary outcome of interest was the incidence rate and severity of bradycardia after remdesivir administration. We defined mild bradycardia as a heart rate of 51-59 beats per minute, moderate bradycardia as a heart rate of 41-50 beats per minute, and severe bradycardia as a heart rate of ≤40 beats per minute. We also performed univariable and multivariable regression analyses to determine potential bradycardia risk factors. Baseline characteristics were reported as means with standard deviations or medians with interquartile ranges (IQRs). All the statistical tests are shown as odds ratios (ORs) with 95% confidence intervals (CIs). Results: In total, 1,635 patients were included in this study. The median age with IQR was 68 (57-79) years and 51.7% of the patients were male. In total, 606 (37.1%) patients developed bradycardia. Among them, 437 patients (26.7%) developed mild bradycardia, 158 patients (9.7%) moderate bradycardia, while 11 patients (0.7%) experienced severe bradycardia. In our adjusted multivariate logistic regression, the odds of bradycardia development after remdesivir administration were higher among patients with age ≥65 years (OR 1.76, 95% CI: 1.04-2.99, p = 0.04), those with hypertension (OR 1.37, 95% CI: 1.07-1.75, p = 0.01), and obesity (OR 1.32, 95% CI: 1.02-1.68, p = 0.03). Conclusion: More than 1 out of 3 patients (37%) who received remdesivir for COVID-19 developed bradycardia with the majority of these patients developing mild or moderate bradycardia that is usually a benign manifestation not needing treatment in most cases. Age ≥65 years, hypertension, and obesity were potential risk factors for remdesivir-associated bradycardia among hospitalized COVID-19 patients. Clinicians should be aware of this adverse event and consider close clinical monitoring for patients at high risk for this adverse event.
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Affiliation(s)
- Yazed Saleh Alsowaida
- Division of Infectious Diseases, Department of Medicine, The Warren Alpert Medical School, Brown University and Rhode Island Hospital, Providence, RI, United States,Department of Clinical Pharmacy, College of Pharmacy, Hail University, Hail, Saudi Arabia,*Correspondence: Yazed Saleh Alsowaida, ; Eleftherios Mylonakis,
| | - Fadi Shehadeh
- Division of Infectious Diseases, Department of Medicine, The Warren Alpert Medical School, Brown University and Rhode Island Hospital, Providence, RI, United States,School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - Markos Kalligeros
- Division of Infectious Diseases, Department of Medicine, The Warren Alpert Medical School, Brown University and Rhode Island Hospital, Providence, RI, United States
| | - Eleftherios Mylonakis
- Division of Infectious Diseases, Department of Medicine, The Warren Alpert Medical School, Brown University and Rhode Island Hospital, Providence, RI, United States,*Correspondence: Yazed Saleh Alsowaida, ; Eleftherios Mylonakis,
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8
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Hajimoradi M, Sharif Kashani B, Dastan F, Aghdasi S, Abedini A, Naghashzadeh F, Mohamadifar A, Keshmiri MS, Noorali S, Lookzadeh S, Alizadeh N, Siri MA, Tavasolpanahi M, Abdolmohammadi Y, Shafaghi M, Rouhani ZS, Shafaghi S. Remdesivir associated sinus bradycardia in patients with COVID-19: A prospective longitudinal study. Front Pharmacol 2023; 13:1107198. [PMID: 36733376 PMCID: PMC9888491 DOI: 10.3389/fphar.2022.1107198] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 12/29/2022] [Indexed: 01/18/2023] Open
Abstract
Background: Remdesivir is effective against SARS-Cov-2 with little evidence of its adverse effect on the cardiac system. The aim of the present study is investigating the incidence of bradycardia in COVID-19 patients treated with Remdesivir. Methods: This prospective longitudinal study was conducted in a tertiary center on COVID-19 patients for Remdesivir therapy. The objectives were to investigate the incidence of sinus bradycardia, and also the association between their demographics, underlying diseases, and the disease severity with developing bradycardia in COVID-19 patients treated with Remdesivir. Results: Of 177 patients, 44% were male. The mean (±standard deviation) age of patients was 49.79 ± 15.16 years old. Also, 33% were hospitalized due to more severe symptoms. Oxygen support was required for all hospitalized subjects. A total of 40% of the patients had comorbidities, with the most common comorbidity being hypertension. The overall incidence of bradycardia (heart rate<60 bpm) in patients receiving Remdesivir was 27%, of whom 70% had extreme bradycardia (heart rate <50 bpm). There was also a statistically significant reduction in heart rate after five doses of Remdesivir compared to the baseline heart rates. In the multivariable model, none of the covariates including age above 60 years, female sex, CRP>50 mg/L, O2 saturation<90%, underlying cardiovascular disease, hypertension and diabetes mellitus, and beta-blockers were associated with Remdesivir-induced bradycardia. No association was found between the COVID-19 severity indicators and bradycardia. Conclusion: As sinus bradycardia is a prevalent adverse cardiac effect of Remdesivir, it is recommended that all COVID-19 patients receiving Remdesivir, be evaluated for heart rate based on examination; and in the case of bradyarrhythmia, cardiac monitoring should be performed during administration to prevent adverse drug reactions.
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Affiliation(s)
- Maryam Hajimoradi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Sharif Kashani
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzaneh Dastan
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran,Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Aghdasi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Abedini
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farah Naghashzadeh
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arezoo Mohamadifar
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Sadegh Keshmiri
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sima Noorali
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somayeh Lookzadeh
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloufar Alizadeh
- Department of Biostatistics, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Amin Siri
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadali Tavasolpanahi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yazdan Abdolmohammadi
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Shafaghi
- Strategic Planning and Executive Office Manager of International Federation of Inventors' Associations-IFIA, Geneva, Switzerland
| | - Zahra Sadat Rouhani
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shadi Shafaghi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran,*Correspondence: Shadi Shafaghi,
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9
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Khan S, Mustafa A, Elhosseiny SM, Rizvi T, Lafferty J. Permanent Pacemaker Placement Secondary to Remdesivir Induced Bradycardia: A Case Report. Cureus 2022; 14:e30923. [DOI: 10.7759/cureus.30923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 11/07/2022] Open
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10
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Pantazopoulos I, Mavrovounis G, Dimeas G, Zikos N, Pitsikou M, Rousogianni E, Mermiri M, Michou A, Spanos M, Maniotis C, Chalkias A, Laou E, Zakynthinos G, Chatzis D, Gourgoulianis K. Remdesivir-induced Bradycardia is not Associated with Worse Outcome in Patients with COVID-19: A Retrospective Analysis. Am J Cardiovasc Drugs 2022; 22:705-710. [PMID: 36002783 PMCID: PMC9402406 DOI: 10.1007/s40256-022-00547-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 12/20/2022]
Abstract
Background COVID-19, is primarily a respiratory illness but is known to cause extrapulmonary manifestations, especially on the cardiovascular system. Bradycardia is commonly reported in COVID-19 patients despite no prior history of occurrence, and many studies have shown an association with increased mortality. Multiple case reports have been published showcasing remdesivir potentially causing bradycardia. Our aim was to investigate the incidence of bradycardia in patients receiving remdesivir and examine the association with disease severity and survival outcomes. Methods A retrospective study was performed including 160 COVID-19 patients receiving remdesivir for 5 days. Patients’ demographics, comorbidities, medication, vital signs, laboratory tests and outcome were recorded. Bradycardia was defined as a heart rate < 60 beats/min and severe bradycardia < 50 beats/min. Results One hundred eighteen (73.8%) patients experienced at least one episode of bradycardia during hospitalisation. Bradycardia was present in 12 (7.5%) patients before treatment with remdesivir. The rate of bradycardia increased up to the 6th day of hospitalisation (40.6%) and subsequently diminished and normalised within 5 days after the last remdesivir dose (5% at Day 10). Severe bradycardia was observed in 13 (7.5%) patients. No difference was observed in ICU admission between groups (bradycardia vs no bradycardia). When we stratified patients according to the outcome of hospitalisation, no significant difference was observed in the occurrence of bradycardia between groups (alive vs dead) [p = 0.853]. Conclusions Treatment with remdesivir may be associated with new-onset bradycardia in hospitalised patients with COVID-19. However, bradycardia is transient and is not associated with ICU admission and mortality.
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Affiliation(s)
- Ioannis Pantazopoulos
- Department of Emergency Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece.
| | - Georgios Mavrovounis
- Department of Emergency Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
| | - Georgios Dimeas
- Department of Emergency Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
| | - Nikolaos Zikos
- Department of Emergency Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
| | - Maria Pitsikou
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
| | - Eleni Rousogianni
- Department of Emergency Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
| | - Maria Mermiri
- Department of Anaesthesiology, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
| | - Anastasia Michou
- Department of Anaesthesiology, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
| | - Michalis Spanos
- Department of Emergency Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
| | | | - Athanasios Chalkias
- Department of Anaesthesiology, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
| | - Eleni Laou
- Department of Anaesthesiology, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
| | | | | | - Konstantinos Gourgoulianis
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
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11
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Cogliati Dezza F, Oliva A, Mauro V, Romani FE, Aronica R, Savelloni G, Casali E, Valeri S, Cancelli F, Mastroianni CM. Real-life use of remdesivir-containing regimens in COVID-19: a retrospective case-control study. LE INFEZIONI IN MEDICINA 2022; 30:211-222. [PMID: 35693052 PMCID: PMC9177180 DOI: 10.53854/liim-3002-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Remdesivir (REM) has shown potent antiviral activity in vitro and efficacy in animal models of COVID-19; nevertheless, clinical trials and real-life reports have shown conflicting data on its effectiveness. Aims of the study were to evaluate the impact of remdesivir on I) Intensive Care Unit (ICU) admission, II) need for orotracheal intubation (OTI) and III) in-hospital mortality. Furthermore, we estimated the kinetics of laboratory parameters and assessed the risk factors for in-hospital mortality in the remdesivir population. METHODS We conducted a retrospective, single-center, case-control (1:1) study including hospitalized patients with confirmed SARS-CoV-2 infection. Cases were patients treated with remdesivir for 5 days, controls were patients not receiving remdesivir. RESULTS A total of 192 patients (96 cases and 96 controls) were included in the study. Patients receiving remdesivir had a lower rate of ICU admission and need for OTI than controls, whereas no difference between cases and controls were observed as for mortality rate. However, at multivariable analysis remdesivir was not associated with ICU admission neither with OTI. Instead, presence of haematological malignancies, lower duration of symptoms, higher severity of infection and low lymphocytes count at admission were independently associated with in-hospital mortality. In patients treated with remdesivir a low albumin value and duration of lymphopenia were significantly associated with mortality. CONCLUSIONS Our real-life study showed that therapy with remdesivir did not have impact on either ICU admission, need for OTI or in-hospital mortality.
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Affiliation(s)
- Francesco Cogliati Dezza
- Department of Public Health and Infectious Diseases, Sapienza University, AOU Policlinico Umberto I, Rome, Italy
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University, AOU Policlinico Umberto I, Rome, Italy
| | - Vera Mauro
- Department of Public Health and Infectious Diseases, Sapienza University, AOU Policlinico Umberto I, Rome, Italy
| | - Francesco Eugenio Romani
- Department of Public Health and Infectious Diseases, Sapienza University, AOU Policlinico Umberto I, Rome, Italy
| | - Raissa Aronica
- Department of Public Health and Infectious Diseases, Sapienza University, AOU Policlinico Umberto I, Rome, Italy
| | - Giulia Savelloni
- Department of Public Health and Infectious Diseases, Sapienza University, AOU Policlinico Umberto I, Rome, Italy
| | - Elena Casali
- Department of Public Health and Infectious Diseases, Sapienza University, AOU Policlinico Umberto I, Rome, Italy
| | - Serena Valeri
- Department of Public Health and Infectious Diseases, Sapienza University, AOU Policlinico Umberto I, Rome, Italy
| | - Francesca Cancelli
- Department of Public Health and Infectious Diseases, Sapienza University, AOU Policlinico Umberto I, Rome, Italy
| | - Claudio Maria Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University, AOU Policlinico Umberto I, Rome, Italy
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12
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Lucijanic M, Cikara T, Bistrovic P, Papic I, Hadziabdic MO, Busic N, Lackovic M, Cesar N, Koscak V, Mitrovic J, Barsic B, Lucijanic T. Remdesivir use in COVID-19 patients might predispose bacteremia, matched case-control analysis. J Infect 2022; 85:174-211. [PMID: 35513188 PMCID: PMC9060712 DOI: 10.1016/j.jinf.2022.04.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 12/11/2022]
Affiliation(s)
- Marko Lucijanic
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia; University of Zagreb School of Medicine, Zagreb, Croatia.
| | - Tomislav Cikara
- Cardiology Department, University Hospital Dubrava, Zagreb, Croatia
| | - Petra Bistrovic
- Cardiology Department, University Hospital Dubrava, Zagreb, Croatia
| | - Ivan Papic
- Pharmacy Deaprtment, University Hospital Dubrava, Zagreb, Croatia
| | - Maja Ortner Hadziabdic
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Nikolina Busic
- Department of Internal Medicine, University Hospital Dubrava, Zagreb, Croatia
| | - Marina Lackovic
- Quality Department, University Hospital Dubrava, Zagreb, Croatia
| | - Natalia Cesar
- Quality Department, University Hospital Dubrava, Zagreb, Croatia
| | - Valentina Koscak
- Quality Department, University Hospital Dubrava, Zagreb, Croatia
| | - Josko Mitrovic
- University of Zagreb School of Medicine, Zagreb, Croatia; Department of Internal Medicine, University Hospital Dubrava, Zagreb, Croatia; Clinical Immunology, Allergology and Rheumatology department, University hospital Dubrava, Zagreb, Croatia
| | - Bruno Barsic
- University of Zagreb School of Medicine, Zagreb, Croatia; Department of Internal Medicine, University Hospital Dubrava, Zagreb, Croatia
| | - Tomo Lucijanic
- Endocrinology Department, University Hospital Dubrava, Zagreb, Croatia
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13
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Fakhar M, Zakariaei Z, Sharifpour A, Banimostafavi ES, Pourmousa R, Soleymani M, Ghasemi M. Post‐COVID‐19 maxillary osteonecrosis and floating maxillary teeth due to mucormycosis in two uncontrolled diabetic patients. Clin Case Rep 2022; 10:e05502. [PMID: 35310314 PMCID: PMC8908082 DOI: 10.1002/ccr3.5502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/13/2021] [Accepted: 01/26/2022] [Indexed: 11/09/2022] Open
Abstract
Mucormycosis is a rare, invasive, quickly progressing fungal infection that generally affects patients who are immunocompromised. If left untreated, the disease is characterized by progressive necrosis and is often fatal. We present two cases of post‐COVID‐19 mucormycosis with a history of several years of uncontrolled diabetic mellitus. Mucormycosis is an opportunistic invasive fungal infection that commonly affects patients who are immunocompromised. If left untreated, it is often fatal following rhinocerebral involvement.
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Affiliation(s)
- Mahdi Fakhar
- Toxoplasmosis Research Center Communicable Diseases Institute Iranian National Registry Center for Lophomoniasis and Toxoplasmosis Imam Khomeini Hospital Mazandaran University of Medical Sciences Sari Iran
| | - Zakaria Zakariaei
- Toxoplasmosis Research Center Communicable Diseases Institute Iranian National Registry Center for Lophomoniasis and Toxoplasmosis Imam Khomeini Hospital Mazandaran University of Medical Sciences Sari Iran
- Toxicology and Forensic Medicine Division Orthopedic Research Center Imam Khomeini Hospital Mazandaran University of Medical Sciences Sari Iran
| | - Ali Sharifpour
- Toxoplasmosis Research Center Communicable Diseases Institute Iranian National Registry Center for Lophomoniasis and Toxoplasmosis Imam Khomeini Hospital Mazandaran University of Medical Sciences Sari Iran
- Pulmonary and Critical Care Division Imam Khomeini Hospital Mazandaran University of Medical Sciences Sari Iran
| | - Elham Sadat Banimostafavi
- Toxoplasmosis Research Center Communicable Diseases Institute Iranian National Registry Center for Lophomoniasis and Toxoplasmosis Imam Khomeini Hospital Mazandaran University of Medical Sciences Sari Iran
- Department of Radiology Imam Khomeini Hospital Mazandaran University of Medical Sciences Sari Iran
| | - Rostam Pourmousa
- Toxoplasmosis Research Center Communicable Diseases Institute Iranian National Registry Center for Lophomoniasis and Toxoplasmosis Imam Khomeini Hospital Mazandaran University of Medical Sciences Sari Iran
| | - Mostafa Soleymani
- Toxoplasmosis Research Center Communicable Diseases Institute Iranian National Registry Center for Lophomoniasis and Toxoplasmosis Imam Khomeini Hospital Mazandaran University of Medical Sciences Sari Iran
| | - Maryam Ghasemi
- Department of Pathology Faculty of Medicine Mazandaran University of Medical Sciences Sari Iran
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14
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Nagamine T, Randhawa S, Nishimura Y, Huang R, Leesutipornchai T, Benavente K, Yoshimura S, Zhang J, Kanitsorphan C. Characteristics of bradyarrhythmia in patients with COVID-19: Systematic scoping review. Pacing Clin Electrophysiol 2022; 45:556-566. [PMID: 35182433 PMCID: PMC9115401 DOI: 10.1111/pace.14466] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/16/2022] [Accepted: 01/30/2022] [Indexed: 11/26/2022]
Abstract
COVID‐19 has recently been associated with the development of bradyarrhythmias, although its mechanism is still unclear. We aim to summarize the existing evidence regarding bradyarrhythmia in COVID‐19 and provide future directions for research. Following the PRISMA Extension for Scoping Reviews, we searched MEDLINE and EMBASE for all peer‐reviewed articles using keywords including“Bradycardia,” “atrioventricular block,” and “COVID‐19″ from their inception to October 13, 2021. Forty‐three articles, including 11 observational studies and 59 cases from case reports and series, were included in the systematic review. Although some observational studies reported increased mortality in those with bradyarrhythmia and COVID‐19, the lack of comparative groups and small sample sizes hinder the ability to draw definitive conclusions. Among 59 COVID‐19 patients with bradycardia from case reports and series, bradycardia most often occurred in those with severe or critical COVID‐19, and complete heart block occurred in the majority of cases despite preserved LVEF (55.9%). Pacemaker insertion was required in 76.3% of the patients, most of which were permanent implants (45.8%). This systematic review summarizes the current evidence and characteristics of bradyarrhythmia in patients with COVID‐19. Further studies are critical to assess the reversibility of bradyarrhythmia in COVID‐19 patients and to clarify potential therapeutic targets including the need for permanent pacing.
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Affiliation(s)
- Todd Nagamine
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, 96813, USA
| | - Sandeep Randhawa
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, 96813, USA
| | - Yoshito Nishimura
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, 96813, USA
| | - Ricky Huang
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, 96813, USA
| | - Thiratest Leesutipornchai
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, 96813, USA
| | - Kevin Benavente
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, 96813, USA
| | - Stephanie Yoshimura
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, 96813, USA
| | - James Zhang
- Queen's Heart Institute, The Queen's Medical Center, Honolulu, HI, 96813, USA
| | - Chanavuth Kanitsorphan
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, 96813, USA
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15
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Brunetti ND, Poliseno M, Bottalico IF, Centola A, Montemurro L, Sica S, Santantonio T, Lo Caputo S. Safety and heart rate changes in Covid-19 patients treated with Remdesivir. Int J Infect Dis 2021; 112:254-257. [PMID: 34551344 PMCID: PMC8451471 DOI: 10.1016/j.ijid.2021.09.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/11/2021] [Accepted: 09/15/2021] [Indexed: 12/23/2022] Open
Abstract
Objectives Limited data are available regarding the occurrence and the extent of cardiac rhythm disturbances in patients with COVID-19 treated with Remdesivir. Methods We present a case series of 52 patients who underwent daily electrocardiogram (ECG) examination after Remdesivir administration. Results Compared to baseline, a significant heart rate reduction was observed after initiation of Remdesivir; however, no case of severe bradycardia or arrhythmias leading to significant clinical complications or Remdesivir discontinuation occurred. Heart rate reduction was proportional to baseline heart rate values (r=0.75, p<0.001). By multivariate analysis, a less severe clinical presentation of Covid-19 (beta=0.47, p<0.01) was related to lower heart rate levels observed after Remdesivir administration. Conclusions Despite a significant reduction in heart rate observed after Remdesivir administration, no severe cardiovascular toxicity was observed in Covid-19 patients, even in the case of cardiovascular comorbidities.
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Affiliation(s)
| | | | | | - Antonio Centola
- Cardiology Department, Policlinico Riuniti University Hospital, Foggia, Italy.
| | - Laura Montemurro
- Department of Clinical and Experimental Medicine, University of Foggia, Italy.
| | - Salvatore Sica
- Infectious Diseases Unit Policlinico Riuniti University Hospital, Foggia, Italy.
| | - Teresa Santantonio
- Department of Clinical and Experimental Medicine, University of Foggia, Italy.
| | - Sergio Lo Caputo
- Department of Clinical and Experimental Medicine, University of Foggia, Italy.
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