Inherited Risk of Sudden Death Triggered by COVID-19 Vaccination
SCN5A Channelopathy Variants Give Clues for Who May be Next
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I mentioned on Tucker Carlson last week in commentary on Buffalo Bills player Damar Hamlin that genetic conditions will be considered. There is an array of known sodium, potassium, and other ion channel mutations in the heart that pose a genetic proclivity to sudden death. In severe mutational cases, the channelopathy is the sole determinant. Many other circumstances, the baseline abnormality and then a superimposed insult to the heart. Two papers (Lim from Korea, Ittiwut from Thailand) now have found that SCN5A variants for cardiomyocyte channels by genetic assessment or by clinical determination on ECG (Brugada pattern) explain cases of sudden death after vaccination.
Lim KH, Park JS. COVID-19 Vaccination-Induced Ventricular Fibrillation in an Afebrile Patient With Brugada Syndrome. J Korean Med Sci. 2022 Oct 31;37(42):e306. doi: 10.3346/jkms.2022.37.e306. PMID: 36325610; PMCID: PMC9623033.
The Brugada pattern and sudden death is known to be triggered by fever, thus the reactogenic phase of vaccination with fever itself may explain the initiation of VT/VF and cardiac arrest.
Ittiwut C, Mahasirimongkol S, Srisont S, Ittiwut R, Chockjamsai M, Durongkadech P, Sawaengdee W, Khunphon A, Larpadisorn K, Wattanapokayakit S, Wetchaphanphesat S, Arunotong S, Srimahachota S, Pittayawonganon C, Thammawijaya P, Sutdan D, Doungngern P, Khongphatthanayothin A, Kerr SJ, Shotelersuk V. Genetic basis of sudden death after COVID-19 vaccination in Thailand. Heart Rhythm. 2022 Aug 5;19(11):1874–9. doi: 10.1016/j.hrthm.2022.07.019. Epub ahead of print. PMID: 35934244; PMCID: PMC9352648.
I am disappointed that world class electrophysiology research departments at US medical schools are being outclassed by investigators in Asia. COVID-19 vaccine induced myocarditis and sudden death should be a top research priority for every cardiology division in the country at this time.
These papers raise the concept that not all patients after the injection or those with manifest COVID-19 vaccine-induced myocarditis are at risk for sudden death. In my clinical practice I incorporate genetic testing for channelopathies to fine tune the prognosis for patients. Let’s hope Damar Hamlin gets high quality of care and critical thinking by electrophysiologists who understand the COVID-19 vaccine induced myocarditis can be fatal in the setting of a channelopathy such as SCN5A and probably many others.
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Sources
Dr. McCullough on Tucker Carlson Tonight, Jan 3, 2023
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