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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 1 2 , Pietro Enea Lazzerini 1 2 , Viola Salvini 1 2 , Alessandra Cartocci 3 , Decoroso Verrengia 1 2 , Tommaso Marzotti 1 2 , Fabio Salvadori 1 2 , Stefania Bisogno 1 2 , Gabriele Cevenini 3 , Michele Voglino 1 2 , Severino Gallo 1 2 , Sabrina Pacini 1 2 , Martina Pazzaglia 1 2 , Angelica Tansini 1 2 , Ambra Otranto 1 2 , Franco Laghi-Pasini 1 2 , Maurizio Acampa 4 , Mohamed Boutjdir 5 6 , Pier Leopoldo Capecchi 1 2
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 1 2 , Pietro Enea Lazzerini 1 2 , Viola Salvini 1 2 , Alessandra Cartocci 3 , Decoroso Verrengia 1 2 , Tommaso Marzotti 1 2 , Fabio Salvadori 1 2 , Stefania Bisogno 1 2 , Gabriele Cevenini 3 , Michele Voglino 1 2 , Severino Gallo 1 2 , Sabrina Pacini 1 2 , Martina Pazzaglia 1 2 , Angelica Tansini 1 2 , Ambra Otranto 1 2 , Franco Laghi-Pasini 1 2 , Maurizio Acampa 4 , Mohamed Boutjdir 5 6 , Pier Leopoldo Capecchi 1 2
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.