IJCS | Volume 32, Nº2, May/June 2019

288 1. WorldHealth Organization (WHO) Hepatitis C: fact sheet.[Cited in 2017 Apr 23]. Available from :http://www.who.int/mediacentre/factsheets/ fs164/en/ 2. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância Prevenção e Controle das IST do HIV/Aids e das Hepatites Virais. 2017. Boletim Epidemiológico Hepatites Virais. References Rezende et al. Cardiac disorders in chronic hepatitis C Int J Cardiovasc Sci. 2019;32(3)283-289 Review Article disorders caused by the association between sofosbuvir and amiodarone are related to the intracellular calcium management in themyocytes, influencing themechanism of excitation-contraction coupling. This disorder, whose molecular mechanisms involved were not elucidated, would affect the duration of the potential of action and the automatism of the cardiac cells. 35 One of the cases of bradycardia reported in the treatment of hepatitis C with new antiviral agents was associated with the use of the beta-blocker propranolol, a drug widely used in patients with chronic liver disease, especially with cases of portal hypertension. The drug interaction of this agent with the direct-acting antivirals would not be expected according to the pharmacokinetic properties of these substances. 34 In fact, the rare occurrence of severe bradyarrhythmia during the treatment of hepatitis C using the new direct- acting antivirals is not well understood. Caldeira et al., in a meta-analysis involving six large studies, did not find cardiovascular events in 1,625 patients using antiviral regimens, including sofosbuvir. 36 Durante-Mangoni et al., 37 studied 26 patients with HCV using sofosbuvir treatment regimens by performing serial ECGs during treatment, not observing changes in HR behavior, including in patients using beta-blocker, suggesting that this medication does not present an additional risk to the development of bradyarrhythmia in association with new antiviral agents. 37 Hagiwara et al., 38 described the cardiovascular disorders related to antiviral treatment in 3 cases (3.3%), among 91 patients using sofosbuvir and ledispavir. According to the authors, one of the patients presented bradycardia and increased QT interval, another patient developed atrial fibrillation and a third patient had increased QT interval associated with previous heart failure. The three patients presented clinical improvement with discontinuation of treatment. 38 Conclusion The questioning of the association between hepatitis C and the onset of heart diseases has been a target of study and controversy in recent years. A body of evidence suggests that HCV can directly or indirectly cause structural and electrical heart disorders, especially in cases of advanced liver disease. However, there is no consensus among the authors that HCV infection would be a risk factor for coronary artery disease and the onset of primary cardiomyopathies. Similarly, it is still unclear whether treatment of hepatitis Cwith direct-acting antivirals could cause severe bradyarrhythmia or whether this risk is particularly observed with the combination of amiodarone or other drug interactions. While new studies do not clarify these issues, these hypotheses should not be overlooked in the clinical approach of this infection. Author contributions Conception and design of the research: Rezende AGS. Acquisition of data: Rezende AGS. Analysis and interpretation of the data: Rezende AGS. Writing of the manuscript: Rezende AGS. Critical revision of the manuscript for intellectual content: Rezende AGS, Lopes EP, Markman-Filho B. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This article is part of the thesis of master submitted by Andre Gustavo da Silva Rezende, from Programa de pós-graduação do Centro de Ciências da Saúde . Ethics approval and consent to participate This article does not contain any studies with human participants or animals performed by any of the authors.