Abstract

Atrial fibrillation and COVID-19 vaccination: Current understanding and insights from the literature

Author(s): Rosanna Ruggiero*, Nunzia Balzano, Gorizio Pieretti, Federica Fraenza, Consiglia Riccardi, Francesco Rossi, Annalisa Capuano

In the battle against the COVID-19 pandemic, vaccines and mass vaccination programs played a fundamental role in reducing the total number of COVID-19 related severe cases, hospitalizations, and deaths. During the pre-authorization studies, it was observed that anti-COVID-19 vaccine side effects were generally mild and resolved within a few days after vaccination. However, their wide administration revealed some possible, albeit rare, adverse events related to COVID-19 vaccines. Among the rare adverse events the cardiac ones arose. Beyond carditis, other cardiac adverse events were described in the literature as suspected adverse events to COVID-19 vaccines. These include cardiac arrhythmias. Some articles published in the literature described Atrial Fibrillation (AF) episodes that occurred in vaccinated subjects, suggesting that COVID-19 vaccination may lead to this arrhythmia. For this reason, we review the data published in the literature describing AF as a suspected adverse event that occurred following the administration of a COVID-19 vaccine. Data regarding AF occurrence following COVID-19 vaccination mainly come from case reports and pharmacovigilance database analyses. The possible underlying mechanisms remain unclear. Aberrant inflammatory responses and activation or dysregulation of the immune system could be involved in the biological plausibility of AF induced by COVID-19 immunization. However, it is essential to balance these risks against the substantial benefits of vaccination, particularly as COVID-19 infection itself is associated with significant cardiovascular risks, including new-onset AF. Ongoing pharmacovigilance and further research are necessary to understand this hypothetical association better. Despite some reported cases, current regulatory assessments do not indicate a clear causal relationship.