The following are key points to remember from an American Heart Association scientific statement on arrhythmias and autonomic dysfunction associated with coronavirus disease 2019 (COVID-19):

1. COVID-19 infections can have serious short- and long-term cardiovascular consequences, including a wide range of arrhythmias. Arrhythmic manifestations with COVID-19 span the spectrum of innocuous and benign to life-threatening and deadly.
2. Various pathophysiological mechanisms have been proposed. The development of arrhythmias and autonomic dysfunction during and after COVID-19 infection is likely multifactorial in most cases.
3. This document reviews the available evidence on the epidemiology, pathophysiology, clinical presentation, and management of cardiac arrhythmias and autonomic dysfunction in patients infected with and recovering from COVID-19 and provides evidence-based guidance.
4. Bradyarrhythmias during COVID-19 infection tend to occur in severe infections and improve with resolution of the infection, with most patients not requiring permanent pacemakers.
5. Patients with newly diagnosed atrial fibrillation during COVID-19 infection should be monitored long-term for recurrence and receive anticoagulation per current guidelines. Ventricular arrhythmias and sudden cardiac death occur at a higher frequency among patients with COVID-19, and the best treatment currently is prompt treatment of COVID-19.
6. Autonomic dysfunction occurs primarily in the setting of postacute sequelae of COVID-19 (PASC), and the precise cause of PASC remains elusive. Many cases of PASC–autonomic dysfunction represent postural orthostatic tachycardia syndrome, orthostatic hypotension, or inappropriate sinus tachycardia.
7. Of note, ritonavir, a component of paxlovid, is a strong inhibitor of CYP-3A4 and can cause significant drug-drug interactions with antiarrhythmics, anticoagulants, antibiotics, and immunosuppressives.
8. Continued long-term arrhythmia surveillance is prudent in any patient who develops a COVID infection. Myocarditis is a well-documented adverse effect of COVID-19 infection but seldom results in serious arrhythmias.
9. There is currently no consistent evidence to demonstrate a heightened risk of arrhythmia or sudden death attributable to COVID-19 vaccination in the general population.
10. Clinically stable and ambulatory COVID-19–positive individuals are at substantially less risk for arrhythmias compared with those with severe infections. Finally, management of arrhythmias/autonomic dysfunction during and after COVID-19 infection should be based on current guidelines for the respective arrhythmia/autonomic dysfunction.

Clinical Topics: Arrhythmias and Clinical EP, COVID-19 Hub, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Prevention

Keywords: Arrhythmias, Cardiac, Autonomic Nervous System Diseases, COVID-19

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