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COVID-19: Electrophysiological mechanisms underlying sudden cardiac death during exercise with facemasks.
Lee, Sharen; Li, Guoliang; Liu, Tong; Tse, Gary.
  • Lee S; Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Hong Kong, China.
  • Li G; Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an 710061, China.
  • Liu T; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China.
  • Tse G; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China. Electronic address: gary.tse@doctors.org.uk.
Med Hypotheses ; 144: 110177, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-720650
ABSTRACT
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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Exercise / Death, Sudden, Cardiac / Electrophysiological Phenomena / COVID-19 / Masks Type of study: Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: Med Hypotheses Year: 2020 Document Type: Article Affiliation country: J.mehy.2020.110177

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Exercise / Death, Sudden, Cardiac / Electrophysiological Phenomena / COVID-19 / Masks Type of study: Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: Med Hypotheses Year: 2020 Document Type: Article Affiliation country: J.mehy.2020.110177