“Frequent Premature Ventricular Contraction and Non-Sustained Ventricular Tachycardia After the SARS-CoV-2 Vaccination in Patient with Implantable Cardioverter Defibrillator Due to Acquired Long-QT Syndrome” This component in a patient that has recently undergone a new vaccine administration might have played an important role and has to be taken into account however, there are some important red flags related to vaccine-induced arrhythmias that we cannot overlook. Tachycardia or increased heart rate can be a physiological or stress-related response after vaccination and is also called an immunization stress-related response (ISRR). The analysis of the vigilance database showed that one of the most frequent symptoms described after SARS-CoV-2 vaccination is palpitations. Interestingly the COVID vaccine was the only one that was been found to be related to this side effect. ![]() The review of the literature for post-vaccine heart rhythm disorders yielded several cases of heart rhythm disorders after mRNA COVID vaccination ( Table 1). We experienced several patients complaining of palpitations or worsening of palpitations and arrhythmic events after mRNA COVID vaccination in our clinical practice. Data from the Literature and Vigilance Databases In light of these findings, we analyzed the molecular pathway by which the mRNA COVID vaccine can impact cardiac electrophysiology and bring forth heart rhythm disorders.Ģ. Still, the disturbance of heart rhythm is not a minor issue and, considering some red flags reported in the literature, it is very important to properly investigate the topic. Since less than 10% of the arrhythmias are symptomatic, epidemiological comparison of the incidence of heart rhythm disorders in patients pre- and post-COVID vaccination is not achievable from the available data. Moreover, unlike myocarditis, none of the other vaccines were described in case reports or other publications to have this side effect. We found that heart rhythm disorders are more common than myopericarditis, the “most famous” vaccine side effect, and deserve more clinical and scientific attention. A review of case reports and clinical studies on the topic and an analysis of the data from official vigilance databases of the mRNA vaccine were performed. We detected post-vaccine arrhythmias in several patients in our clinical practice and further investigated the issue. ![]() Myocarditis and pericarditis are the most commonly highlighted, but there is a side effect which, in our view, has not yet been thoroughly investigated namely heart rhythm disorders. The vaccines based on the mRNA vaccine platform are considered safer and are spreading all over the world nonetheless, side effects are being reported. Some questions regarding the safety of COVID-19 vaccines have been raised due to sparse reports of severe systemic reactions after vaccination. Since all COVID-19 vaccines are new drugs, monitoring their adverse events post-approval is essential. However, in addition to efficacy, safety is an important issue for any vaccine. SARS-CoV-2 vaccination has significantly reduced disease-related hospitalizations and mortality, protecting the healthcare and economic systems from an imminent crash. In light of these findings, we reviewed the potential molecular pathways for the COVID vaccine to impact cardiac electrophysiology and cause heart rhythm disorders. Although the risk–benefit ratio is clearly in favor of vaccination, heart rhythm disorders are not a negligible issue, and there are red flags in the literature about the risk of post-vaccination malignant arrhythmias in some predisposed patients. ![]() Since the COVID vaccine is the only vaccination related to this side effect, questions arose about whether these vaccines could affect heart conduction. ![]() Reviewing the official vigilance database, we found that heart rhythm disorders after COVID vaccination are not uncommon and deserve more clinical and scientific attention. We report a case series of patients affected by cardiac arrhythmias post-mRNA vaccine from our clinical practice and the literature. Myopericarditis is the major, but not the only cardiovascular complication of this vaccine hence it is important not to underestimate other side effects. The mRNA-based vaccine platform is considered to be safe, but side effects are being reported more frequently as more and more people around the world become treated. SARS-CoV-2 vaccination offered the opportunity to emerge from the pandemic and, thereby, worldwide health, social, and economic disasters.
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