959-07 - REMDESIVIR INDUCED HEART BLOCK

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Author Block: Shazia Pathan, Atif Tatari, Dignity Health St. Rose Dominican, Las Vegas, NV, USA
Background: This is a rare documentation of Remdesivir induced heart block and a discussion on its implications.
Case: Elderly admitted for acute respiratory failure from COVID-19 pneumonia and started on Remdesivir. Initial EKG: SR, rate 92, 1st degree AV block. TTE: EF 65-70%, no valvular maladies. On day 2, telemetry noted 2nd degree AV block. Day 3, this progressed to AV dissociation. The patient had no cardiac history.
Decision‐making: Remdesivir was discontinued. Day 4, the patient had Mobitz I, II; brief 3rd degree. Days 5-8 showed rare Mobitz I; but no further A-V dissociation. Day 9, he returned to baseline. Notably, the patient remained asymptomatic during the bradyarrhythmias. Hypotheses: Remdesivir, as an adenosine analog, may bind to receptors in the heart (pertinently A1), slow heart rate & cause AV blocks. Moreover, Remdesivir may affect RNA nonspecifically, eliciting mitochondrial dysfunction. By competitively inhibiting ATP, it may also disrupt ion channel gradients & cardiac action potentials.
Conclusion: This case presents a life-threatening drug reaction, advocating telemetry monitoring with Remdesivir. The patient being asymptomatic, while in complete A-V dissociation, suggests that this may be more common than we have clinically recognized. The half-life of Remdesivir’s active metabolite, GS-441524, is ~27 hours. A drug clears in ~5 half-lives, aligning with this patient's return to baseline. Recognition is pivotal in avoiding invasive PPM placement, or sudden cardiac arrest.