Dados do Trabalho

Título

Acute Viral Myopericarditis Associated with Atrial Fibrillation Post-Infection COVID-19 in mountain bike athlete: Case Report and Literature Review

Introdução e Objetivo

The presentation of myocarditis after Sars-CoV-2 infection was reported in 2.3% of American athletes. Our case describes a 40-year-old male mountain bike athlete who was previously healthy, who developed myocarditis after infection with the new coronavirus concomitant with cardiac arrhythmia, which had a period of remission, , however with the return of vigorous physical activity presented recurrence of atrial fibrillation requiring cardiac ablation and, after a multidisciplinary treatment approach has fully recovered and restarted the training program.

Casuística e Método

The case presented concerns a 40-year-old mountain bike athlete who developed myocarditis after infection with the new coronavirus concomitant with cardiac arrhythmia, which had a period of remission, however, with the return to vigorous physical activity, he presented recurrence of atrial fibrillation requiring cardiac ablation and, after a multidisciplinary treatment approach has fully recovered and restarted the training program. In cases where myocarditis manifests with cardiac arrhythmia the restriction of physical activity for six months and follow-up for return is the preferred option, mainly, because the deconditioning time should be taken into account in order to avoid further complications.

Resultados

In the case of myocarditis induced by Sars-CoV-2, this phenomenon is reported in 2.3% in North American athletes, with clinical and subclinical cases 8 ,and reached 10% of cases in Wuhan, associated or not with cardiac arrhythmias. However, the prevalence is still uncertain by the variety of data reported around the world. Moreover, myocarditis allows the formation of fibrotic tissue, presenting itself as a predisposing factor for arrhythmias. In a global study conducted with 4,526 patients hospitalized with the Sars-CoV-2 virus, approximately 18% had arrhythmia due to the disease, and 81.8% of these alterations were atrial arrhythmias.

Discussão

In the case reported above, it was observed that physical exercise triggered a cardiac arrhythmia that did not return to regular patterns in the recovery period, causing the athlete to undergo an ablation. After compliance with the period of removal (colocar palavra melhor) and correction of the arrhythmia, a new CPET was requested, as recommended by the guidelines in order to define a safe return to sports practice. However, we observed a 28% reduction in VO2 in the first (1st) ventilatory threshold and a 22% reduction in VO2peak when comparing the first CPET to the second (2nd), however, there was no change in respiratory fitness. This finding, denotes, for a high-performance athlete, a worsening in physical conditioning, which can be attributed to the rest period, as well as the possible effects resulting from pulmonary infection by the new coronavirus, not directly the failure of the heart pump, since ECG did not present alterations suggestive of ischemia or arrhythmias and ultrasound and radiological control tests did not present a remaining lesion.

Conclusão

SARS-CoV-2 infection in athletes can present with cardiac manifestations, such as acute myocarditis and arrhythmias, requiring monitoring and follow-up. Complementary exams such as cardiopulmonary tests and echocardiograms can help with the return to medium and high intensity training. Controlling the return to sports practice has become indispensable, as there is still no evidence in the literature on the late development of myocardial dysfunction in these patients.