Given the current widespread use of remdesivir and the comparatively modest attention placed on its potential cardiac pharmacodynamic properties, a better understanding of the clinical implications of RAB is warranted. It is not entirely clear whether drugs used in the treatment of COVID-19 that have QT interval-prolonging properties or certain drug–drug interactions also induce bradycardia. The potential etiology for COVID-19 arrhythmogenicity is manifold and includes myocardial insults (infarction, myocarditis), hypoxic injury, a systemic inflammatory response, autonomic disturbance, and electrolyte abnormalities. Furthermore, patients with severe disease may be more prone to incident bradycardia. Bradycardia in the context of COVID-19 may be associated with increased rates of mortality. Likewise, the association between COVID-19 and sinus bradycardia is well documented in the literature. RAB appears to occur at a disproportionate rate when compared to other pharmaceuticals administered to patients with COVID-19, but only a few studies have appreciated the clinically relevant outcomes that result from the bradycardia. However, despite its wide utilization, there remains a paucity of data regarding the cardiac-related clinical outcomes of remdesivir. Remdesivir antiviral therapy has offered a potential decrease in recovery time for COVID-19 patients, with an acceptable side effect profile. Adenosine is known to exert a negative chronotropic and dromotropic effect by slowing sinoatrial automaticity GS-441524 may lead to RAB via a similar mechanism to adenosine. One proposed mechanism of RAB refers to remdesivir’s active metabolite, GS-441524, a nucleotide triphosphate derivative similar in structure to adenosine. RAB is fairly common, with a reported incidence of 21–60%. found an increased risk of reporting bradycardia following the use of remdesivir compared to other drugs, a finding consistent with a number of case reports and observational studies. One such phenomenon is remdesivir-associated bradycardia (RAB). Although the drug has been studied extensively in clinical trials, the cardiac side effect profile of remdesivir is not well studied. Remdesivir is an antiviral prodrug of a nucleotide analog and currently a mainstay therapy in the treatment of coronavirus disease 2019 (COVID-19).
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