Treatment of chronic hepatitis C virus (HCV) infection has dramatically improved since the advent of direct anti-viral agents, including Sofosbuvir. Sustained virological response may be achieved in more than 90% of patients without interferon, ensuring broad use of these regimens. To date, several thousands of patients have been treated with Sofosbuvir-based regimens worldwide. Since their approval in France, combination therapy is given to patients with complications, including cirrhosis and life-threatening extra-hepatic manifestations.

We analyzed retrospectively the incidence of arrhythmias and conduction disorder in a cohort of patients treated by Sofosbuvir (new anti-viral HCV) in our hospital from January 2, 2014 to December 31, 2014.

We observed five cases (1.2%) of severe arrhythmia, including three cardiac conduction defects, within the first days of Sofosbuvir-based therapy among 415 patients who had been treated in our center. There were two females and three males. The median age was 58 (50-75) years. Two patients were coinfected with HIV. Arrhythmia relapsed when Sofosbuvir was reintroduced in one patient. Among the 3 conduction disorders, one patient was under beta-blocker and amiodarone another. A pacemaker was implanted in all 3 patients with conduction disorders. The three patients who underwent a pacemaker implantation were not pacemaker-dependent, on the controls after stopping antiviral treatments (figure 1).

Sofosbuvir seems to have cardiac toxicity. The mechanism underlying Sofosbuvir cardiotoxicity has to be determined. A particular attention should be given to patients with a medical history of rhythm or conduction abnormalities, including careful monitoring (e.g., Holter ECG recordings) of cardiac rhythm during the first days of Sofosbuvir therapy.