Your browser doesn't support javascript.
Cardiac Arrest Risk During Acute Infections: Systemic Inflammation Directly Prolongs QTc Interval via Cytokine-Mediated Effects on Potassium Channel Expression.
Lazzerini, Pietro Enea; Acampa, Maurizio; Laghi-Pasini, Franco; Bertolozzi, Iacopo; Finizola, Francesco; Vanni, Francesca; Natale, Mariarita; Bisogno, Stefania; Cevenini, Gabriele; Cartocci, Alessandra; Giabbani, Beatrice; Migliacci, Nicola; D'Errico, Antonio; Dokollari, Alexander; Maccherini, Massimo; Boutjdir, Mohamed; Capecchi, Pier Leopoldo.
  • Lazzerini PE; Department of Medical Sciences, Surgery and Neurosciences (P.E.L., F.L.-P., F.F., F.V., M.N., S.B., B.G., N.M., A. D'Errico, P.L.C.), University Hospital of Siena, Italy.
  • Acampa M; Stroke Unit (M.A.), University Hospital of Siena, Italy.
  • Laghi-Pasini F; Department of Medical Sciences, Surgery and Neurosciences (P.E.L., F.L.-P., F.F., F.V., M.N., S.B., B.G., N.M., A. D'Errico, P.L.C.), University Hospital of Siena, Italy.
  • Bertolozzi I; Cardiology Intensive Therapy Unit, Department of Internal Medicine, Hospital of Carrara, Italy (I.B.).
  • Finizola F; Department of Medical Sciences, Surgery and Neurosciences (P.E.L., F.L.-P., F.F., F.V., M.N., S.B., B.G., N.M., A. D'Errico, P.L.C.), University Hospital of Siena, Italy.
  • Vanni F; Department of Medical Sciences, Surgery and Neurosciences (P.E.L., F.L.-P., F.F., F.V., M.N., S.B., B.G., N.M., A. D'Errico, P.L.C.), University Hospital of Siena, Italy.
  • Natale M; Department of Medical Sciences, Surgery and Neurosciences (P.E.L., F.L.-P., F.F., F.V., M.N., S.B., B.G., N.M., A. D'Errico, P.L.C.), University Hospital of Siena, Italy.
  • Bisogno S; Department of Medical Sciences, Surgery and Neurosciences (P.E.L., F.L.-P., F.F., F.V., M.N., S.B., B.G., N.M., A. D'Errico, P.L.C.), University Hospital of Siena, Italy.
  • Cevenini G; Department of Medical Biotechnologies (G.C., A.C.), University Hospital of Siena, Italy.
  • Cartocci A; Department of Medical Biotechnologies (G.C., A.C.), University Hospital of Siena, Italy.
  • Giabbani B; Department of Medical Sciences, Surgery and Neurosciences (P.E.L., F.L.-P., F.F., F.V., M.N., S.B., B.G., N.M., A. D'Errico, P.L.C.), University Hospital of Siena, Italy.
  • Migliacci N; Department of Medical Sciences, Surgery and Neurosciences (P.E.L., F.L.-P., F.F., F.V., M.N., S.B., B.G., N.M., A. D'Errico, P.L.C.), University Hospital of Siena, Italy.
  • D'Errico A; Department of Medical Sciences, Surgery and Neurosciences (P.E.L., F.L.-P., F.F., F.V., M.N., S.B., B.G., N.M., A. D'Errico, P.L.C.), University Hospital of Siena, Italy.
  • Dokollari A; Department of Cardiac Surgery (A. Dokollari, M.M.), University Hospital of Siena, Italy.
  • Maccherini M; Department of Cardiovascular Surgery, Saint Michael Hospital, University of Toronto, Ontario, Canada (A. Dokollari).
  • Boutjdir M; Department of Cardiac Surgery (A. Dokollari, M.M.), University Hospital of Siena, Italy.
  • Capecchi PL; VA New York Harbor Healthcare System, SUNY Downstate Medical Center (M.B.).
Circ Arrhythm Electrophysiol ; 13(8): e008627, 2020 08.
Article in English | MEDLINE | ID: covidwho-641777
ABSTRACT

BACKGROUND:

During acute infections, the risk of malignant ventricular arrhythmias is increased, partly because of a higher propensity to develop QTc prolongation. Although it is generally believed that QTc changes almost exclusively result from concomitant treatment with QT-prolonging antimicrobials, direct effects of inflammatory cytokines on ventricular repolarization are increasingly recognized. We hypothesized that systemic inflammation per se can significantly prolong QTc during acute infections, via cytokine-mediated changes in K+ channel expression.

METHODS:

We evaluated (1) the frequency of QTc prolongation and its association with inflammatory markers, in patients with different types of acute infections, during active disease and remission; (2) the prevalence of acute infections in a cohort of consecutive patients with Torsades de Pointes; (3) the relationship between K+ channel mRNA levels in ventricles and peripheral blood mononuclear cells and their changes in patients with acute infection over time.

RESULTS:

In patients with acute infections, regardless of concomitant QT-prolonging antimicrobial treatments, QTc was significantly prolonged but rapidly normalized in parallel to CRP (C-reactive protein) and cytokine level reduction. Consistently in the Torsades de Pointes cohort, concomitant acute infections were highly prevalent (30%), despite only a minority (25%) of these cases were treated with QT-prolonging antimicrobials. KCNJ2 K+ channel expression in peripheral blood mononuclear cell, which strongly correlated to that in ventricles, inversely associated to CRP and IL (interleukin)-1 changes in acute infection patients.

CONCLUSIONS:

During acute infections, systemic inflammation rapidly induces cytokine-mediated ventricular electrical remodeling and significant QTc prolongation, regardless concomitant antimicrobial therapy. Although transient, these changes may significantly increase the risk of life-threatening ventricular arrhythmia in these patients. It is timely and warranted to transpose these findings to the current coronavirus disease 2019 (COVID-19) pandemic, in which both increased amounts of circulating cytokines and cardiac arrhythmias are demonstrated along with a frequent concomitant treatment with several QT-prolonging drugs. Graphic Abstract A graphic abstract is available for this article.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Leukocytes, Mononuclear / Communicable Diseases / Cytokines / Torsades de Pointes / Potassium Channels, Inwardly Rectifying / Heart Arrest / Heart Rate / Heart Ventricles / Inflammation Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Adult / Aged / Female / Humans / Male / Middle aged / Young adult Language: English Journal: Circ Arrhythm Electrophysiol Journal subject: Vascular Diseases / Cardiology Year: 2020 Document Type: Article Affiliation country: CIRCEP.120.008627

Similar

MEDLINE

...
LILACS

LIS


Full text: Available Collection: International databases Database: MEDLINE Main subject: Leukocytes, Mononuclear / Communicable Diseases / Cytokines / Torsades de Pointes / Potassium Channels, Inwardly Rectifying / Heart Arrest / Heart Rate / Heart Ventricles / Inflammation Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Adult / Aged / Female / Humans / Male / Middle aged / Young adult Language: English Journal: Circ Arrhythm Electrophysiol Journal subject: Vascular Diseases / Cardiology Year: 2020 Document Type: Article Affiliation country: CIRCEP.120.008627