Genetic Susceptibility Underlies Greater Risk for Arrhythmia, SCD in Blacks With COVID-19

Black male in hospital, ECG, myocardial infarction
Black male in hospital, ECG, myocardial infarction
African Americans may be at greater risk for ventricular arrhythmias and sudden cardiac death if infected with SARS-CoV-2, due to genetic susceptibility and environmental factors.

African Americans may be at greater risk for ventricular arrhythmias and sudden cardiac death if infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19), due to genetic susceptibility and environmental factors, according to a review published in Heart Rhythm.

Health disparities in the United States are highlighted by the COVID-19 pandemic. Specifically, the risk for infection by SARS-CoV-2 and COVID-19 outcomes have been found to vary with age, sex, and racial demographics. The mortality rate associated with COVID-19 was found to be up to 6-fold higher in predominantly black vs white counties.

Common ion channel variants p.Asp85Asn-KCNE1 and p.Ser1103Tyr-SCN5A, the latter of which is found mostly in people of African descent, have been associated with an increased risk for drug-induced long QT syndrome (DI-LQTS) and drug-induced sudden cardiac death (DI-SCD). Patients with COVID-19 who are administered chloroquine or hydroxychloroquine and azithromycin are especially at risk for DI-SCD and DI-LQTS.

In individuals of African descent, the presence of p.Ser1103Tyr-SCN5A has been associated with an increased risk for ventricular arrhythmia and sudden cardiac death. It is estimated that during the pandemic, 1 in 13 African Americans may be at an increased risk for ventricular arrhythmias that may be lethal, due to the pro-arrhythmic nature of p.Ser1103Tyr-SCN5A.

Approximately 6% of patients hospitalized for COVID-19 cases are thought to have life-threatening ventricular arrhythmia. These arrythmias are fueled by an underlying myocardial injury or stress, a prominent feature of COVID-19.

“[G]iven the potential for COVID-19 to exacerbate known gene-environment interactions pertaining to the potentially pro-arrhythmic p.Ser1103Tyr-SCN5A common variant, it seems reasonable to…avoid using COVID-19-directed, QTc-prolonging drugs…unless careful, and preferably personal protective equipment-sparing, cardiac monitoring can be implemented…and determine the clinical utility of QTc-shortening agents such as late sodium current blockers…to better protect at-risk individuals, especially African Americans in the context of the ongoing COVID-19 pandemic,” noted the review authors.

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Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Giudicessi JR, Roden DM, Wilde AAM, Ackerman MJ. Genetic susceptibility for COVID-19-associated sudden cardiac death in African Americans [published online May 4, 2020]. Heart Rhythm. doi:10.1016/j.hrthm.2020.04.045