tetano
Editor, Senior Moderator
J Arrhythm
. 2024 Jul 31;40(5):1137-1148.
doi: 10.1002/joa3.13114. eCollection 2024 Oct. Increased interleukin-6 levels are associated with atrioventricular conduction delay in severe COVID-19 patients
Riccardo Accioli[SUP] 1 2 [/SUP], Pietro Enea Lazzerini[SUP] 1 2 [/SUP], Viola Salvini[SUP] 1 2 [/SUP], Alessandra Cartocci[SUP] 3 [/SUP], Decoroso Verrengia[SUP] 1 2 [/SUP], Tommaso Marzotti[SUP] 1 2 [/SUP], Fabio Salvadori[SUP] 1 2 [/SUP], Stefania Bisogno[SUP] 1 2 [/SUP], Gabriele Cevenini[SUP] 3 [/SUP], Michele Voglino[SUP] 1 2 [/SUP], Severino Gallo[SUP] 1 2 [/SUP], Sabrina Pacini[SUP] 1 2 [/SUP], Martina Pazzaglia[SUP] 1 2 [/SUP], Angelica Tansini[SUP] 1 2 [/SUP], Ambra Otranto[SUP] 1 2 [/SUP], Franco Laghi-Pasini[SUP] 1 2 [/SUP], Maurizio Acampa[SUP] 4 [/SUP], Mohamed Boutjdir[SUP] 5 6 [/SUP], Pier Leopoldo Capecchi[SUP] 1 2 [/SUP]
Affiliations
Background: Severely ill patients with coronavirus disease 2019 (COVID-19) show an increased risk of new-onset atrioventricular blocks (AVBs), associated with high rates of short-term mortality. Recent data suggest that the uncontrolled inflammatory activation observed in these patients, specifically interleukin (IL)-6 elevation, may play an important pathogenic role by directly affecting cardiac electrophysiology. The aim of our study was to assess the acute impact of IL-6 changes on electrocardiographic indices of atrioventricular conduction in severe COVID-19.
Methods: We investigated (1) the behavior of PR-interval and PR-segment in patients with severe COVID-19 during active phase and recovery, and (2) their association with circulating IL-6 levels over time.
Results: During active disease, COVID-19 patients showed a significant increase of PR-interval and PR-segment. Such atrioventricular delay was transient as these parameters rapidly normalized during recovery. PR-indices significantly correlated with circulating IL-6 levels over time. All these changes and correlations persisted also in the absence of laboratory signs of cardiac strain/injury or concomitant treatment with PR-prolonging drugs, repurposed or not.
Conclusions: Our study provides evidence that in patients with severe COVID-19 and high-grade systemic inflammation, IL-6 elevation is associated with a significant delay of atrioventricular conduction, independent of concomitant confounding factors. While transient, such alterations may enhance the risk of severe AVB and associated short-term mortality. Our data provide further support to current anti-inflammatory strategies for severe COVID-19, including IL-6 antagonists.
Keywords: COVID‐19; PR‐interval; PR‐segment; atrioventricular block; interleukin‐6.
. 2024 Jul 31;40(5):1137-1148.
doi: 10.1002/joa3.13114. eCollection 2024 Oct. Increased interleukin-6 levels are associated with atrioventricular conduction delay in severe COVID-19 patients
Riccardo Accioli[SUP] 1 2 [/SUP], Pietro Enea Lazzerini[SUP] 1 2 [/SUP], Viola Salvini[SUP] 1 2 [/SUP], Alessandra Cartocci[SUP] 3 [/SUP], Decoroso Verrengia[SUP] 1 2 [/SUP], Tommaso Marzotti[SUP] 1 2 [/SUP], Fabio Salvadori[SUP] 1 2 [/SUP], Stefania Bisogno[SUP] 1 2 [/SUP], Gabriele Cevenini[SUP] 3 [/SUP], Michele Voglino[SUP] 1 2 [/SUP], Severino Gallo[SUP] 1 2 [/SUP], Sabrina Pacini[SUP] 1 2 [/SUP], Martina Pazzaglia[SUP] 1 2 [/SUP], Angelica Tansini[SUP] 1 2 [/SUP], Ambra Otranto[SUP] 1 2 [/SUP], Franco Laghi-Pasini[SUP] 1 2 [/SUP], Maurizio Acampa[SUP] 4 [/SUP], Mohamed Boutjdir[SUP] 5 6 [/SUP], Pier Leopoldo Capecchi[SUP] 1 2 [/SUP]
Affiliations
- PMID: 39416238
- PMCID: PMC11474750
- DOI: 10.1002/joa3.13114
Background: Severely ill patients with coronavirus disease 2019 (COVID-19) show an increased risk of new-onset atrioventricular blocks (AVBs), associated with high rates of short-term mortality. Recent data suggest that the uncontrolled inflammatory activation observed in these patients, specifically interleukin (IL)-6 elevation, may play an important pathogenic role by directly affecting cardiac electrophysiology. The aim of our study was to assess the acute impact of IL-6 changes on electrocardiographic indices of atrioventricular conduction in severe COVID-19.
Methods: We investigated (1) the behavior of PR-interval and PR-segment in patients with severe COVID-19 during active phase and recovery, and (2) their association with circulating IL-6 levels over time.
Results: During active disease, COVID-19 patients showed a significant increase of PR-interval and PR-segment. Such atrioventricular delay was transient as these parameters rapidly normalized during recovery. PR-indices significantly correlated with circulating IL-6 levels over time. All these changes and correlations persisted also in the absence of laboratory signs of cardiac strain/injury or concomitant treatment with PR-prolonging drugs, repurposed or not.
Conclusions: Our study provides evidence that in patients with severe COVID-19 and high-grade systemic inflammation, IL-6 elevation is associated with a significant delay of atrioventricular conduction, independent of concomitant confounding factors. While transient, such alterations may enhance the risk of severe AVB and associated short-term mortality. Our data provide further support to current anti-inflammatory strategies for severe COVID-19, including IL-6 antagonists.
Keywords: COVID‐19; PR‐interval; PR‐segment; atrioventricular block; interleukin‐6.