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Lee PY, Garan H, Wan EY, Scully BE, Biviano A, Yarmohammadi H. Cardiac arrhythmias in viral infections. J Interv Card Electrophysiol 2023; 66:1939-1953. [PMID: 36929368 PMCID: PMC10019413 DOI: 10.1007/s10840-023-01525-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/08/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND The current COVID-19 pandemic has led to many studies examining its arrhythmogenic effects. However, there are many other viruses that are capable of inducing arrhythmias that have not received as much attention. The objective of this study was to review common viruses and identify studies highlighting their arrhythmogenic effects. METHODS AND RESULTS In this review, we examined 15 viruses and the literature regarding their arrhythmogenic effects. The common mechanisms of action appear to be direct invasion of myocytes leading to immune mediated damage, infection of vascular endothelium, and alteration of cardiac ion channels. CONCLUSIONS This review highlights the growing evidence that supports the involvement of other viral infections in the development of arrhythmia. Physicians should be aware of these potentially life-threatening effects when caring for patients with these viruses, some of which are very common. Additional studies are required to better understand the complex mechanism and risk factors of cardiac arrhythmias in patients suffered from viral infections to determine whether the processes can be reversed or even prevented.
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Affiliation(s)
- Paul Y Lee
- Department of Medicine, Rutgers University, Newark, NJ, USA
| | - Hasan Garan
- Department of Medicine, Division of Cardiology, New York Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, New York Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Brian E Scully
- Department of Medicine, New York Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Angelo Biviano
- Department of Medicine, Division of Cardiology, New York Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Hirad Yarmohammadi
- Department of Medicine, Division of Cardiology, New York Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
- Cardiology and Cardiac Electrophysiology, Columbia University, 177 Fort Washington Avenue, New York, NY, 10032, USA.
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2
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Sinus node dysfunction and atrial fibrillation-Relationships, clinical phenotypes, new mechanisms, and treatment approaches. Ageing Res Rev 2023; 86:101890. [PMID: 36813137 DOI: 10.1016/j.arr.2023.101890] [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: 11/16/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
Although the anatomical basis of the pathogenesis of sinus node dysfunction (SND) and atrial fibrillation (AF) is located primarily in the left and right atria, increasing evidence suggests a strong correlation between SND and AF, in terms of both clinical presentation and formation mechanisms. However, the exact mechanisms underlying this association are unclear. The relationship between SND and AF may not be causal, but is likely to involve common factors and mechanisms, including ion channel remodeling, gap junction abnormalities, structural remodeling, genetic mutations, neuromodulation abnormalities, the effects of adenosine on cardiomyocytes, oxidative stress, and viral infections. Ion channel remodeling manifests primarily as alterations in the "funny" current (If) and Ca2+ clock associated with cardiomyocyte autoregulation, and gap junction abnormalities are manifested primarily as decreased expression of connexins (Cxs) mediating electrical impulse propagation in cardiomyocytes. Structural remodeling refers primarily to fibrosis and cardiac amyloidosis (CA). Some genetic mutations can also cause arrhythmias, such as SCN5A, HCN4, EMD, and PITX2. The intrinsic cardiac autonomic nervous system (ICANS), a regulator of the heart's physiological functions, triggers arrhythmias.In addition, we discuss arrhythmias caused by viral infections, notably Coronavirus Disease 2019 (COVID-19). Similarly to upstream treatments for atrial cardiomyopathy such as alleviating CA, ganglionated plexus (GP) ablation acts on the common mechanisms between SND and AF, thus achieving a dual therapeutic effect.
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Braiman D, Konstantino Y, Westreich R. When the brain slows the heart-herpes encephalitis and sinus arrest: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab254. [PMID: 34377921 PMCID: PMC8343447 DOI: 10.1093/ehjcr/ytab254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/19/2021] [Accepted: 06/10/2021] [Indexed: 11/12/2022]
Abstract
Background Herpes simplex virus (HSV) encephalitis is a known cause of cognitive deterioration, neurological disturbances, and seizures though are rarely associated with sinus node dysfunction. Case summary We present a 54-year-old man admitted to the hospital with a 10-day history of fever, confusion, and fatigue, 1 week following a transient loss of consciousness. An initial workup suggested HSV encephalitis and the patient was started on intravenous Acyclovir. Due to his episode of syncope, a 24 h Holter electrocardiogram monitoring was performed. The Holter documented multiple episodes of sinus arrest, with a second episode of syncope noticed by the hospital staff concurrent with the last documented sinus arrest. Following antiviral treatment and resolution of the encephalitis we noticed complete resolution of sinus node dysfunction. We subsequently avoided permanent pacemaker implantation. Discussion Our case of proven HSV encephalitis complicated by sinus node arrest and syncope with complete resolution following antiviral treatment suggests no indication for permanent pacemaker implantation. This approach is consistent with data from previously reported cases.
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Affiliation(s)
- Dana Braiman
- Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, 84101, Beer-Sheva, Israel.,Department of Cardiology, Electrophysiology Unit, Soroka University Medical Center, 84101, Be'er Sheva, Israel
| | - Yuval Konstantino
- Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, 84101, Beer-Sheva, Israel.,Department of Cardiology, Electrophysiology Unit, Soroka University Medical Center, 84101, Be'er Sheva, Israel
| | - Roi Westreich
- Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, 84101, Beer-Sheva, Israel.,Department of Cardiology, Electrophysiology Unit, Soroka University Medical Center, 84101, Be'er Sheva, Israel
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Zhou M, Wong CK, Un KC, Lau YM, Lee JCY, Tam FCC, Lau YM, Lai WH, Tam AR, Lam YY, Pang P, Tong T, Tang M, Tse HF, Ho D, Ng MY, Chan EW, Wong ICK, Lau CP, Hung IFN, Siu CW. Cardiovascular sequalae in uncomplicated COVID-19 survivors. PLoS One 2021; 16:e0246732. [PMID: 33571321 PMCID: PMC7877588 DOI: 10.1371/journal.pone.0246732] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 01/26/2021] [Indexed: 01/19/2023] Open
Abstract
Background A high proportion of COVID-19 patients were reported to have cardiac involvements. Data pertaining to cardiac sequalae is of urgent importance to define subsequent cardiac surveillance. Methods We performed a systematic cardiac screening for 97 consecutive COVID-19 survivors including electrocardiogram (ECG), echocardiography, serum troponin and NT-proBNP assay 1–4 weeks after hospital discharge. Treadmill exercise test and cardiac magnetic resonance imaging (CMR) were performed according to initial screening results. Results The mean age was 46.5 ± 18.6 years; 53.6% were men. All were classified with non-severe disease without overt cardiac manifestations and did not require intensive care. Median hospitalization stay was 17 days and median duration from discharge to screening was 11 days. Cardiac abnormalities were detected in 42.3% including sinus bradycardia (29.9%), newly detected T-wave abnormality (8.2%), elevated troponin level (6.2%), newly detected atrial fibrillation (1.0%), and newly detected left ventricular systolic dysfunction with elevated NT-proBNP level (1.0%). Significant sinus bradycardia with heart rate below 50 bpm was detected in 7.2% COVID-19 survivors, which appeared to be self-limiting and recovered over time. For COVID-19 survivors with persistent elevation of troponin level after discharge or newly detected T wave abnormality, echocardiography and CMR did not reveal any evidence of infarct, myocarditis, or left ventricular systolic dysfunction. Conclusion Cardiac abnormality is common amongst COVID-survivors with mild disease, which is mostly self-limiting. Nonetheless, cardiac surveillance in form of ECG and/or serum biomarkers may be advisable to detect more severe cardiac involvement including atrial fibrillation and left ventricular dysfunction.
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Affiliation(s)
- Mi Zhou
- Cardiology Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Chun-Ka Wong
- Cardiology Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Ka-Chun Un
- Cardiology Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Yuk-Ming Lau
- Cardiology Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | | | - Frankie Chor-Cheung Tam
- Cardiology Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Yee-Man Lau
- Cardiology Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Wing-Hon Lai
- Cardiology Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Anthony Raymond Tam
- Infectious Disease Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | | | - Polly Pang
- Infectious Disease Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Teresa Tong
- Infectious Disease Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Milky Tang
- Infectious Disease Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Deborah Ho
- Infectious Disease Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, the University of Hong Kong, Hong Kong SAR, China
| | - Esther W. Chan
- Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, the University of Hong Kong, Hong Kong SAR, China
| | - Ian C. K. Wong
- Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, the University of Hong Kong, Hong Kong SAR, China
| | - Chu-Pak Lau
- Cardiology Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Ivan Fan-Ngai Hung
- Infectious Disease Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
- * E-mail: (CWS); (IFNH)
| | - Chung-Wah Siu
- Cardiology Division, Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
- * E-mail: (CWS); (IFNH)
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Ajam M, Abu-Heija AA, Shokr M, Ajam F, Saydain G. Sinus Bradycardia and QT Interval Prolongation in West Nile Virus Encephalitis: A Case Report. Cureus 2019; 11:e3821. [PMID: 30868034 PMCID: PMC6402859 DOI: 10.7759/cureus.3821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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.
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Affiliation(s)
- Mustafa Ajam
- Internal Medicine, Detroit Medical Center - Wayne State University, Detroit, USA
| | - Ahmad A Abu-Heija
- Internal Medicine, Detroit Medical Center - Wayne State University, Detroit, USA
| | - Mohamed Shokr
- Cardiology, Detroit Medical Center - Wayne State University, Detroit, USA
| | - Firas Ajam
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Ghulam Saydain
- Internal Medicine, Detroit Medical Center - Wayne State University, Detroit, USA
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Insular cortex lesion and autonomic instability in a herpes simplex virus encephalitis patient. J Neurovirol 2018; 24:649-651. [DOI: 10.1007/s13365-018-0652-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 03/09/2018] [Accepted: 05/23/2018] [Indexed: 10/28/2022]
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7
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Lee B, Hwang J, Choi YH, Han YJ, Choi YH, Park JD. Disseminated Neonatal Herpes Simplex Virus Infection. Korean J Crit Care Med 2013. [DOI: 10.4266/kjccm.2013.28.4.331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Bongjin Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jinsol Hwang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Yu Hyeon Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Young Joo Han
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - June Dong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Nazif TM, Vázquez J, Honig LS, Dizon JM. Anti-N-methyl-D-aspartate receptor encephalitis: an emerging cause of centrally mediated sinus node dysfunction. Europace 2012; 14:1188-94. [PMID: 22345374 DOI: 10.1093/europace/eus014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AIMS Anti-N-methyl-D-aspartate receptor encephalitis (NMDARE) is a recently recognized form of autoimmune encephalitis that typically affects young women, often as a paraneoplastic syndrome related to ovarian teratoma. Clinical features include psychiatric and neurological disturbances, central hypoventilation, autonomic instability, and cardiac dysrhythmias. The prevalence, nature, and outcomes of cardiac dysrhythmias in patients with NMDARE have not been well described. METHODS AND RESULTS Records of 10 consecutive patients with NMDARE were reviewed to obtain clinical, laboratory, echocardiographic, electrocardiographic, and radiological data. Patients were all female with an average age of 23 ± 5.5 years. Echocardiograms revealed structurally normal hearts with the exception of mild left ventricular hypertrophy in two cases. Eight patients had inappropriate sinus tachycardia. Six patients developed significant sinus bradycardia, which included periods of sinus arrest in four cases. Five patients manifested both sinus bradycardia and tachycardia. Bradycardia was often triggered by identifiable vagal stimuli. Temporary pacing was instituted in three patients, but permanent pacing was not required in any of the patients. Magnetic resonance imaging (MRI) scans revealed mesial temporal abnormalities in nine patients. In all cases, the dysrhythmias resolved with treatment of the underlying immune disorder with immunotherapy and/or teratoma resection. There was no evidence of dysrhythmia recurrence in any patient at follow-up. CONCLUSION Anti-N-methyl-D-aspartate receptor encephalitis is a recently recognized cause of autoimmune encephalitis with a predilection to cause severe sinus node abnormalities. Temporary pacing is occasionally required, but permanent pacing appears to be unnecessary. An analysis of the clinical syndrome coupled with MRI and experimental data may offer insight into central mechanisms of heart rate regulation.
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Affiliation(s)
- Tamim M Nazif
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, Columbia University, 630 W 168th Street, New York, NY 10032, USA
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Gooch R. Ictal asystole secondary to suspected herpes simplex encephalitis: a case report. CASES JOURNAL 2009; 2:9378. [PMID: 20069069 PMCID: PMC2805652 DOI: 10.1186/1757-1626-2-9378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Accepted: 12/22/2009] [Indexed: 11/10/2022]
Abstract
Herpes simplex virus is a leading cause of sporadic encephalitis. While seizures are a common feature of Herpes simplex virus encephalitis, and periods of asystole have been reported in Herpes simplex virus patients, there have been no prior reports of ictal asystole secondary to such an infection.This case report describes a 33 year old, previously healthy, gentleman of Malaysian descent, with new onset seizures resulting in a twenty-one second period of ictal asystole. In hospital the patient developed focal neurological symptoms. A diagnosis of Herpes simplex virus encephalitis was made, although this diagnosis was not confirmed by lumbar puncture, magnetic resonance imaging or biopsy.Literature is reviewed regarding ictal asystole as well as clinical features and cardiac complications of Herpes simplex virus encephalitis. Given the link between ictal asystole and Herpes simplex virus encephalitis, cardiac monitoring would be recommended for Herpes simplex virus encephalitis patients having seizures. The use of anticonvulsants with cardiac side effects should be carefully considered.
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Affiliation(s)
- Robert Gooch
- Schulich School of Medicine and Dentistry, The University of Western Ontario, 61 Gunn Street, London, ON N6G 1C6, Canada
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[Cough syncope caused by a possible Chlamydia pneumoniae pneumonia]. Rev Med Interne 2009; 30:809-11. [PMID: 19586690 DOI: 10.1016/j.revmed.2008.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Revised: 11/14/2008] [Accepted: 12/01/2008] [Indexed: 11/24/2022]
Abstract
We report the case of a 61-year-old man who presented with coughing fits followed by sinus pauses and syncope. Cardiac and neurological diagnostic work-up was negative and the patient was considered to have cough syncope. As this occurred within the context of febrile pneumonia, an infectious disease was suspected but diagnostic work-up only revealed an increase of antibodies against Chlamydia pneumoniae. The responsibility of this agent is discussed. Clinical recovery was obtained with the prescription of antitussive medication.
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