Discussion:
The spectrum of clinical manifestations in Covid-19 is highly variable, potentially causing also asymptomatic or only mildly symptomatic presentation in a large number of cases, and laboratory detection of the viral nucleic acid prone to false-negative results. [5]
To date, this type of presentation with non-severe pneumonia, resolved without any specific antiviral therapy, and concurrent VT storm in a Covid-19 patient has never been reported.
It is known that patients with pre-existing cardiovascular disease have worse outcomes; some authors suggest that Covid-19 infection might be associated with a direct myocardial injury triggering life-threatening ventricular arrhythmias. [6]
Non-specific palpitations were reported as part of the presenting symptomology in 7.3% of patients admitted for Covid-19 disease [2], while cardiac arrhythmias were noted in 44.4% of severely ill hospitalized Covid-19 patients [3], although no specific data regarding the type of arrhythmia was reported.
For the first time we present the case of a patient with VT storm occurring during an atypical pneumonia later proved to be Covid-19.
Despite the important history of pre-existing cardiovascular disease, the patient had never experienced sustained ventricular arrhythmia documented by ICD interrogation, suggesting the role played by SARS-CoV-2 infection as potential arrhythmogenic trigger.
Mechanisms of cardiac arrhythmias in Covid-19 patients may be multifactorial and have not been completely understood yet. Cytokine storm triggered by an imbalanced type 1 and type 2 T helper cells [7], as well as hypoxia-induced intracellular calcium overload leading to early afterdepolarization, may represents a major trigger of reentrant VTs in these patients. [8, 9]
The present report confirms the complexity of the Covid-19 clinical profile and in case of ventricular storm might be helpful for the management of similar situations.