Ventricular ectopy with remdesivir use in COVID-19

ABSTRACT

INTRODUCTION: Remdesivir is an antiviral medication that has demonstrated improvement in time to symptom resolution in Covid-19. The side effect profile documented in literature is still developing. To date, there have been no wide scale demonstrated cardiac toxicities noted. We present a case of COVID-19 who developed ventricular ectopy suspected to be due to Remdesivir. METHODS: A 70-year-old male with a past medical history of coronary artery disease, hypertension, and recurrent aspiration events presented from a nursing home in respiratory distress. The patient initially presented with findings consistent with aspiration pneumonia, however was also found to be positive for Covid-19. Vital signs were positive for fever, tachycardia, tachypnea, and an oxygen saturation of 90% on Non-Rebreather, requiring intubation. Metabolic panel on admission showed a slightly elevated ALT, but no electrolyte abnormalities or altered renal function. A leukocytosis and mild anemia were noted on complete blood count. Admission electrocardiogram was negative for ectopy. Remdesivir therapy for COVID-19 was planned. During infusion of the first dose, the patient had multiple premature ventricular complexes (PVCs) that developed into a short run of non-sustained ventricular tachycardia. During the second dose, PVCs again were noted, and Remdesivir was stopped. After infusion was held, ectopy resolved. Echocardiogram showed an ejection fraction of 60 - 65%, mild tricuspid and mitral regurgitation, and no evidence of wall motion abnormalities. After 48 hours, ectopy was no longer observed. RESULTS: A preliminary report of the Adaptive COVID-19 Treatment Trial evaluated Remdesivir's efficacy and safety. Of the patients receiving it, 29% had grade 3 or 4 adverse reactions, though none were cardiac in nature. In our patient, the onset of ectopy was noted immediately upon infusion and resolved upon abortion of infusion. Postulated mechanisms were drug interactions (carvedilol, atorvastatin, and sertraline were considered), CAD, or underlying disease of the conduction system. Further studies investigating the association of underlying conditions and medications with Remdesivir may shed light on this occurrence.