key: cord-1004035-f4k7919d
authors: Kumar, Sabina; Arcuri, Christina; Chaudhuri, Sumanta; Gupta, Rahul; Aseri, Mahendra; Barve, Pranav; Shah, Shivang
title: Remdesivir therapy associated with Bradycardia in SARS‐CoV2
date: 2021-07-28
journal: Clin Cardiol
DOI: 10.1002/clc.23700
sha: f5eaaa9e3727247557a699668e12629210e2fa61
doc_id: 1004035
cord_uid: f4k7919d

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cause of bradycardia because there was a high incidence of bradycardia in individuals who were not on remdesivir.

The possible mechanism for remdesivir causing bradycardia is still up for debate. The active metabolite is a nucleotide triphosphate which is a derivate similar to adenosine triphosphate (ATP). 2 ATP has been shown to induce SA nodal automaticity through vagal simulation. 3 In addition, ATP metabolite adenosine exerts negative chrontropic and dromotropic effects, which could affect AV nodal conduction. 3 In the future, we agree with Barkas et al. that remdesivir and development of bradycardia needs to be investigated further. Remdesivir has a high affinity to bind to viral polymerases; however, there is a chance for cross-reactivity with human mitochondrial RNA polymerase, which could lead to mitochonridal dysfunction and subsequent cardiomyocte toxicity. Choi et al. showed that the cytotoxic effects of remdesivir increased overtime (48 hours vs. 24 hours), in addition to reducing cell viability. 5 Multiple case reports have also discussed remdesivir-causing bradycardia. 5 8 Through our literature review, we found more than 10 case reports discussing remdesivir administration and subsequent bradycardia. In most of the case reports, there was only a transient bradycardic event followed by normalization of heart rate after the discontinuation of the medication.

We are in the process of pursuing a retrospective analysis looking specifically at the timing of remdesivir and subsequent bradycardia.

We invite anyone to send a message to the corresponding author if they want to collaborate on our study.

A novel study on SARS-COV-2 virus associated bradycardia as a predictor of mortality-retrospective multicenter analysis

Remdesivir for the treatment of COVID-19: final report

The mechanism of the negative chronotropic and dromotropic actions of adenosine 5 0 -triphosphate in the heart: an update

Serious bradycardia and remdesivir for coronavirus 2019 (COVID-19): a new safety concerns

Antiviral activity and safety of remdesivir against SARS-CoV-2 infection in human pluripotent stem cell-derived cardiomyocytes

Marked sinus Bradycardia associated with Remdesivir in COVID-19: a case and literature review

Severe sinus bradycardia associated with remdesivir in a child with severe SARS-CoV-2 infection

Bradycardia associated with remdesivir therapy for COVID-19 in a 59-year-old man