Long QT Syndrome Course Associated with New Coronavirus Infection. Clinical Case

Background. Long QT syndrome is hereditary disease, cardiac canalopathy variant, characterized by syncope and high risk of sudden cardiac death due to occurrence of polymorphic ventricular tachycardia (VT), torsade de pointes, and ventricular fibrillation. Acute respiratory viral infection may aggravate clinical course of primary electrical heart diseases.

Clinical case description. 14-year-old female patient was transferred to infectious diseases hospital from another hospital with positive PCR test on new coronavirus infection (COVID-19) after loss of consciousness in November 2021. Syncope was first noted at the age of 12, however then did not recur, and their examination and treatment were postponed due to the COVID-19 pandemic. Syncopal states continued during COVID-19. Cardiac examination was performed at infectious diseases hospital: recurrent VT, torsade de pointes, was diagnosed along with QT interval prolongation. The girl's condition has improved after the treatment and selection of antiarrhythmic therapy. 15 days later negative PCR test for SARS-CoV-2 was received, and the patient was transferred to specialized hospital, where the long QT syndrome was confirmed, and dual-chamber cardioverter defibrillator was installed.

Conclusion. This clinical case demonstrates that ARVI can aggravate the course of existing primary arrhythmia and emphasizes the crucial role of timely diagnosis and integrated approach to the management of patients with genetically determined cardiac arrhythmias.

1. Giudicessi JR, Roden DM, Wilde AAM, Ackerman MJ. Genetic susceptibility for COVID-19-associated sudden cardiac death in African Americans. Heart Rhythm. 2020;17(9):1487–1492. doi: https://doi.org/10.1016/j.hrthm.2020.04.045

2. Cheng CD, Zhao S, Jiang J, et al. Impact of the COVID-19 pandemic on cardiac implantable electronic device implantation in China: Insights from 2 years of changing pandemic conditions. Front Public Health. 2022;10:1031241. doi: https://doi.org/10.3389/fpubh.2022.1031241

3. Silva Marques J, Veiga A, Nóbrega J, et al. Electrical storm induced by H1N1 A influenza infection. Europace. 2010;12(2): 294–295. doi: https://doi.org/10.1093/europace/eup430.

4. Bereznitskaya VV, Kulbachinskaya EK, Shkolnikova MA. Clinical features and antiarrhythmic therapy in patients with catecholaminergic polymorphic ventricular tachycardia. Journal of Arrhythmology. 2021;28(4):62–69. (In Russ). doi: https://doi.org/10.15690/vsp.v23i2.2740]

5. Zecchin M, Ciminello E, Mari V, et al. A global analysis of implants and replacements of pacemakers and cardioverter-defibrillators before, during, and after the COVID-19 pandemic in Italy. Intern Emerg Med. 2024;19(1):107–114. doi: https://doi.org/10.1007/s11739-023-03450-1

6. Madjid M, Connolly AT, Nabutovsky Y, et al. Effect of High Influenza Activity on Risk of Ventricular Arrhythmias Requiring Therapy in Patients With Implantable Cardiac Defibrillators and Cardiac Resynchronization Therapy Defibrillators. Am J Cardiol. 2019;124(1):44–50. doi: https://doi.org/10.1016/j.amjcard.2019.04.011

7. Sacilotto L, Olivetti NQS, Pisani CF, et al. Peculiar Aspects of Patients with Inherited Arrhythmias during the COVID-19 Pandemic. Arq Bras Cardiol. 2021;117(2):394–403. doi: https://doi.org/10.36660/abc.20200391

8. Junghetu MA, Bălăşescu E, Stratan LM, Ion DA. Pathophysiological correlations between SARS-CoV-2 and arrhythmogenesis: a literature review. Germs. 2024;14(1):63–76. doi: https://doi.org/10.18683/germs.2024.1418

9. Biel B, Skoczyński P, Hrymniak B, et al.Outcomes for patients with implanted cardioverter-defibrillators admitted to the Emergency Department due to electrical shock during the pre-pandemic and COVID-19 era. Kardiol Pol. 2024;82(2):156–165. doi: https://doi.org/10.33963/v.kp.98604

10. Sindrom udlinennogo intervala QT: Clinical guidelines. Ministry of Health of Russian Federation; 2022. 28 p. (In Russ).] Доступно по: https://legalacts.ru/doc/klinicheskie-rekomendatsii-sindrom-udlinennogo-intervalaqt-utv-minzdravom-rossii. Ссылка активна на 18.01.2025.

11. Shkolnikova MA, Kharlap MS, Ildarova RA. Genetically determined cardiac arrythmias. Russian Journal of Cardiology. 2011;(1):8–25. (In Russ).]

12. Lim SM, Pak HN, Lee MH, et al. Fever-induced QTc prolongation and ventricular fibrillation in a healthy young man. Yonsei Med J. 2011;52(6):1025–1027. doi: https://doi.org/10.3349/ymj.2011.52.6.1025

13. Usuda K, Hayashi K, Nakajima T, et al. Mechanisms of feverinduced QT prolongation and torsades de pointes in patients with KCNH2 mutation. Europace. 2023;25(6):161. doi: https://doi.org/10.1093/europace/euad161

14. Burashnikov A, Shimizu W, Antzelevitch C. Fever accentuates transmural dispersion of repolarization and facilitates development of early afterdepolarizations and torsade de pointes under longQT Conditions. Circ Arrhythm Electrophysiol. 2008;1(3):202–208. doi: https://doi.org/10.1161/CIRCEP.107.691931

15. Lahtinen AM, Havulinna AS, Noseworthy PA, et al. Prevalence of arrhythmia-associated gene mutations and risk of sudden cardiac death in the Finnish population. Ann Med. 2013;45(4):328–335. doi: https://doi.org/10.3109/07853890.2013.783995

16. Donner BC, Marschall C, Schmidt KG. A presumably benign human ether-a-go-go-related gene mutation (R176W) with a malignant primary manifestation of long QT syndrome. Cardiol Young. 2012;22(3):360–363. doi: https://doi.org/10.1017/S1047951111001831

17. Michowitz Y, Milman A, Sarquella-Brugada G, et al. Fever-related arrhythmic events in the multicenter Survey on Arrhythmic Events in Brugada Syndrome. Heart Rhythm. 2018;15(9):1394–1401. doi: https://doi.org/10.1016/j.hrthm.2018.04.007

18. Amin AS, Klemens CA, Verkerk AO, et al. Fever-triggered ventricular arrhythmias in Brugada syndrome and type 2 long-QT syndrome. Neth Heart J. 2010;18(3):165–169. doi: https://doi.org/10.1007/BF03091755

19. Belardinelli L, Giles WR, Rajamani S, et al. Cardiac late Na+ current: proarrhythmic effects, roles in long QT syndromes, and pathological relationship to CaMKII and oxidative stress. Heart Rhythm. 2015;12(2):440–448. doi: https://doi.org/10.1016/j.hrthm.2014.11.009

20. Nabeh OA, Helaly MM, Menshawey R, et al. Contemporary approach to understand and manage COVID-19-related arrhythmia. Egypt Heart J. 2021;73(1):76. doi: https://doi.org/10.1186/s43044-021-00201-5

21. Israfilova SKh, Kruchina TK, Novik GA. Arrhythmias in Children with Acute Respiratory Viral Infections: Prevalence and Causes. Voprosy sovremennoi pediatrii — Current Pediatrics. 2024;23(4):220–228. (In Russ). doi: https://doi.org/10.15690/vsp.v23i4.2782]

22. El-Sherif N, Turitto G, Boutjdir M. Acquired Long QT Syndrome and Torsade de Pointes. Pacing Clin Electrophysiol. 2018;41(4): 414–421. doi: https://doi.org/10.1111/pace.13296

23. Rahmadhany A, Sukardi R, Nursyirwan SR, et al. Complete atrioventricular block due to multisystem inflammatory syndrome in children: a case report. Turk J Pediatr. 2022;64(6):1125–1129. doi: https://doi.org/10.24953/turkjped.2022.236

24. Ghazaryan N, Hovakimyan T. Successful management of nearincessant bidirectional ventricular tachycardia in one-year-old child with COVID-19 infection: a case report. Eur Heart J Case Rep. 2023;7(2):ytad064. doi: https://doi.org/10.1093/ehjcr/ytad064

25. Zorzi A, Mattesi G, Frigo AC, et al. Impact of coronavirus disease 19 outbreak on arrhythmic events and mortality among implantable cardioverter defibrillator patients followed up by remote monitoring: a single center study from the Veneto region of Italy. J Cardiovasc Med (Hagerstown). 2022;23(8):546–550. doi: https://doi.org/10.2459/JCM.0000000000001348

26. Zheludochkovye narusheniya ritma. Zheludochkovye tahikardii i vnezapnaya serdechnaya smert’: Clinical guidelines. Ministry of Health of Russian Federation; 2020. 145 p. (In Russ).] Доступно по: https://scardio.ru/content/Guidelines/2020/Clinic_rekom_ZHNR-unlocked.pdf. Ссылка активна на 26.01.2025.