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.


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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