Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
Journal website https://www.cardiologyres.org

Original Article

Volume 13, Number 3, June 2022, pages 135-143

Bradyarrhythmia After Remdesivir Administration in SARS-CoV-2: A Review of Literature and Meta-Analysis of Observational Studies in Epidemiology

Figures

Figure 1.
Figure 1. Flow diagram of study selection for pooled analysis.
Figure 2.
Figure 2. Forest plot showing risk of bradyarrhythmia among cases and controls.
Figure 3.
Figure 3. Funnel plot.
Figure 4.
Figure 4. Map of countries with studies reporting bradyarrhythmia after RDV administration in SARS-CoV-2 infected patients. RDV: remdesivir; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2.

Tables

Table 1. Characteristics of Included Studies for Pooled Meta-Analysis
 
ReferenceCountryStudy designMedian age of cases, n (IQR)Sample size (n) case/controlQuality assessment*
*Quality assessment performed with Newcastle-Ottawa Scale. IQR: interquartile range.
Pallotto et al (2021) [6]ItalyRetrospective cohort66 (58 - 70.2)20/268
Pallotto et al (2021) [7]ItalyRetrospective cohort69 (59 - 80.75)62/798
Attena et al (2021) [8]ItalyProspective cohort65 (54 - 76)100/667

 

Table 2. Case Presentations Reporting Bradyarrhythmia After Remdesivir Administration in SARS-CoV-2 Patients
 
StudyCountryAgeSexLowest HRComorbiditiesClinical presentation
SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; HR: heart rate; LBBB: left bundle branch block; AF: atrial fibrillation.
Abdelmajid et al [9]Qatar55M31DyslipidemiaAsymptomatic
54F37NoneSymptomatic (dizziness and fatigue)
Barkas et al [10]Greece36M39ObesityAsymptomatic
Ching and Lee [11]USA37M40HypertensionAsymptomatic
Chow et al [12]USA16M40ObesityAsymptomatic
Day et al [13]Canada59M50NoneAsymptomatic
Gubitosa et al [14]USA54F34LBBB, hypertension, B-cell lymphomaSymptomatic (angina and hypotension)
Gupta et al [15]USA26F44Asymptomatic
77F48Asymptomatic
Jacinto et al [16]USA78F38Hypertension, prediabetes, dyslipidemia, former tobacco smokerSymptomatic
Maheshwari and Athiraman [17]USA54F57NoneAsymptomatic
54F30Type 2 diabetes mellitusAsymptomatic
Sanchez-Codez et al [18]Spain13M40Episodic asthmaAsymptomatic
Selvaraj et al [19]USA72M30AF, lung cancerAsymptomatic
Shirvani et al [20]Iran52M37DyslipidemiaSymptomatic (dizziness and diaphoresis)
52F23Diabetes, hypothyroidismSymptomatic (angina)
59M30NoneSymptomatic (diaphoresis)
Sneji et al [21]USA65F30HypothyroidismAsymptomatic

 

Table 3. Other Studies Investigating Bradyarrhythmia After Remdesivir Administration in SARS-CoV-2 Patients
 
StudyCountryDesignSample sizeMale cases (%)Findings
SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; RDV: remdesivir; SB: sinus bradycardia; OR: odds ratio; CI: confidence interval.
Brunetti et al [24]ItalyCase series5256Mean heart rate reduction 24 ± 16 bpm after RDV administration
Bistrovic and Lucijanic [26]CroatiaProspective cohort1464Statistically significant rightward T-axis deviation association with RDV
Eleftheriou et al [23]GreeceCase series425Third-fourths (75%) pediatric patients treated with RDV developed asymptomatic bradycardia
Elikowski et al [22]PolandCase series1963.212/19 (63%) patients that developed transient SB were on RDV
Rodriguez-Guerra et al [25]USARetrospective cohort3751.443% of patients on RDV developed bradycardia
Bistrovic et al [27]CroatiaRetrospective cohort47366Bradycardia on day 5 of RDV was significantly associated with lower odds of death (OR 0.33 (95% CI: 0.16 - 0.79); P = 0.014)