Arrhythmias and viral infections

Abstract

Cardiac arrhythmias are major causes of cardiovascular morbidity and mortality worldwide. While structural heart disease and metabolic disorders remain key risk factors, viral infections have emerged as important non-traditional contributors. This thesis presents a systematic review of the literature exploring the relationship between viral infections—such as SARS-CoV-2, influenza, HIV, dengue, and herpesviruses—and the onset, mechanisms, and outcomes of cardiac arrhythmias. The review followed PRISMA guidelines and included clinical, experimental, and pathological studies from peer-reviewed journals. Evidence highlights both direct mechanisms (viral invasion of cardiomyocytes, conduction system damage) and indirect mechanisms (systemic inflammation, immune dysregulation, cytokine storm, and pro-thrombotic states). Myocardial biopsies and imaging studies confirm viral presence and inflammatory injury in arrhythmogenic substrates. General practitioners occupy a central role in early detection, monitoring, and prevention of viral-related arrhythmias. Their holistic and accessible approach allows integrated risk management, long-term follow-up, and preventive education. The advent of artificial intelligence, wearable ECG technologies, and telecardiology has transformed arrhythmia screening and real-time monitoring, enabling earlier intervention and better outcomes. Viral infections thus represent a growing and underrecognized cardiovascular threat. Integrating preventive vaccination, antiviral therapy, AI-assisted diagnostics, and primary care coordination could significantly reduce arrhythmic complications. Future research should promote multicenter studies combining molecular virology, advanced imaging, and digital health tools for a comprehensive understanding of this intersection between infection and electrophysiology.