Cardiac arrhythmias amongst hospitalised Coronavirus 2019 (COVID‐19) patients: Prevalence, characterisation, and clinical algorithm to classify arrhythmic risk

Abstract

Objectives A significant proportion of COVID‐19 patients may have cardiac involvement including arrhythmias. Although arrhythmia characterisation and possible predictors were previously reported, there are conflicting data regarding the exact prevalence of arrhythmias. Clinically applicable algorithms to classify COVID patients' arrhythmic risk are still lacking, and are the aim of our study. Methods We describe a single‐centre cohort of hospitalised patients with a positive nasopharyngeal swab for COVID‐19 during the initial Israeli outbreak between 1/2/2020 and 30/5/2020. The study's outcome was any documented arrhythmia during hospitalisation, based on daily physical examination, routine ECG's, periodic 24‐hour Holter, and continuous monitoring. Multivariate analysis was used to find predictors for new arrhythmias and create classification trees for discriminating patients with high and low arrhythmic risk. Results Out of 390 COVID‐19 patients included, 28 (7.2%) had documented arrhythmias during hospitalisation, including 23 atrial tachyarrhythmias, combined atrial fibrillation (AF), and ventricular fibrillation, ventricular tachycardia storm, and 3 bradyarrhythmias. Only 7/28 patients had previous arrhythmias. Our study showed a significant correlation between disease severity and arrhythmia prevalence (P < .001) with a low arrhythmic prevalence amongst mild disease patients (2%). Multivariate analysis revealed background heart failure (CHF) and disease severity are independently associated with overall arrhythmia while age, CHF, disease severity, and arrhythmic symptoms are associated with tachyarrhythmias. A novel decision tree using age, disease severity, CHF, and troponin levels was created to stratify patients into high and low risk for developing arrhythmia. Conclusions Dominant arrhythmia amongst COVID‐19 patients is AF. Arrhythmia prevalence is associated with age, disease severity, CHF, and troponin levels. A novel simple Classification tree, based on these parameters, can discriminate between high and low arrhythmic risk patients.

Prevalence and Impact of Atrial Fibrillation in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

“…Of the 783 studies identified from the literature search (216 on Pubmed and 567 on EMBASE), 31 studies were selected according to the inclusion and exclusion criteria and included in the analysis [ 3 , 10 , 11 , 12 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ] ( Figure S1 in Supplementary Materials ), with a total of 187,716 COVID-19 patients. Baseline characteristics of the studies included are reported in Table 1 .…”

“…Thirteen studies were held in Europe [ 10 , 11 , 25 , 29 , 31 , 33 , 37 , 39 , 42 , 43 , 44 , 47 , 50 ], nine in North America [ 3 , 28 , 30 , 32 , 41 , 45 , 46 , 49 , 51 ], four in Asia [ 26 , 34 , 35 , 48 ], and five in other geographical locations, including one multinational study [ 12 , 27 , 36 , 38 , 40 ]. Twenty-five studies were observational retrospective [ 3 , 10 , 12 , 26 , 28 , 30 , 31 , 32 , 34 , 35 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ], four were based on prospective observational analysis of single center cohorts [ 11 , …”

“…Notwithstanding this, only few studies have reported about the onset of AF during COVID-19 [ 3 , 10 ], and the actual prevalence and the impact of AF on the prognosis of these patients are still unclear. On the other hand, AF is already recognized as the most common arrhythmia occurring during COVID-19 [ 3 , 11 , 12 ]. This emphasizes the potential for a tight relationship between these two diseases, as well as the clinical relevance of this association.…”

Gerontokardiológia: COVID-19 / Gerontocardiology: COVID-19

“…Arytmie skutočne patria medzi najčastejšie KV komplikácie COVID-19 (vyskytli sa v 7,4 -16,7 %) (44,45), špecificky u seniorov (n = 339, priemerný vek 71 rokov) boli zachytené v 10,4 % (bez sínusovej tachykardie), pričom to bolo podstatne častejšie u zosnulých než žijúcich (20,6 vs 8,1 %, p < 0,001) (34). Incidencia arytmií pri COVID-19 rastie s jeho klinickou závažnosťou a vekom pacientov (46).…”

“…Zdá sa, že najčastejšou arytmiou de-novo vzniknutou počas COVID-19 je fibrilácia predsiení (AF; napríklad u 390 COVID-19 pacientov v Izraeli AF tvorila 80 % novovzniknutých porúch rytmu) (46). Z praktického hľadiska je jednou z rozhodujúcich situácií súbeh AF, tromboprofylaxie (ktorá je u seniorov apriórne indikovaná častejšie ako v mladšom veku) a hemokoagulačnej nerovnováhy, ktorú COVID-19 typicky navodzuje -všeobecné odporúčania meritórnych spoločností nateraz nie sú k dispozícii, preto sa pri indikovaní antikoagulácie zatiaľ budeme prikláňať k individuálnemu posudzovaniu jej rizík u COVID-19 seniora.…”