Subject(s)
Brugada Syndrome , COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Ventricular Fibrillation , Acetaminophen/therapeutic use , Adult , Anti-Arrhythmia Agents/therapeutic use , Antipyretics/therapeutic use , Arrhythmias, Cardiac , Brugada Syndrome/physiopathology , Drug-Related Side Effects and Adverse Reactions , Electrocardiography , Fever/etiology , Humans , Isoproterenol/therapeutic use , Male , Quinidine/therapeutic use , SARS-CoV-2 , Treatment Outcome , Vaccination/adverse effects , Ventricular Fibrillation/etiology , Ventricular Fibrillation/physiopathologySubject(s)
Coronavirus Infections/epidemiology , Heart Arrest/therapy , Heart Valve Diseases/diagnostic imaging , Mitral Valve/diagnostic imaging , Occupational Stress/physiopathology , Physicians , Pneumonia, Viral/epidemiology , Ventricular Fibrillation/therapy , Adult , Betacoronavirus , COVID-19 , Defibrillators, Implantable , Echocardiography , Female , Heart Arrest/diagnosis , Heart Arrest/etiology , Heart Valve Diseases/complications , Heart Valve Diseases/physiopathology , Humans , Magnetic Resonance Imaging , Occupational Stress/complications , Pandemics , SARS-CoV-2 , Ventricular Fibrillation/diagnosis , Ventricular Fibrillation/etiology , Ventricular Fibrillation/physiopathologyABSTRACT
The mandatory use of facemasks is a public health measure implemented by various countries in response to the novel coronavirus disease 19 (COVID-19) pandemic. However, there have been case reports of sudden cardiac death (SCD) with the wearing of facemasks during exercise. In this paper, we hypothesize that exercise with facemasks may increase the risk of ventricular tachycardia/ventricular fibrillation (VT/VF) leading to SCD via the development of acute and/or intermittent hypoxia and hypercapnia. We discuss the potential underlying mechanisms including increases in adrenergic stimulation and oxidative stress leading to electrophysiological abnormalities that promote arrhythmias via non-reentrant and reentrant mechanisms. Given the interplay of multiple variables contributing to the increased arrhythmic risk, we advise avoidance of a facemask during high intensity exercise, or if wearing of a mask is mandatory, exercise intensity should remain low to avoid precipitation of lethal arrhythmias. However, we cannot exclude the possibility of an arrhythmic substrate even with low intensity exercise especially in those with established chronic cardiovascular disease in whom baseline electrophysiological abnormalities may be found.