Cardiac arrhythmias in patients presenting with COVID-19 treated in Portuguese hospitals: A national registry from the Portuguese Association of Arrhythmology, Pacing and Electrophysiology

Abstract

Introduction and objectives In December 2019, SARS-CoV-2, was discovered as the agent of COVID-19 disease. Cardiac arrhythmias have been reported as frequent but their incidence is unknown. The aim of this research was to assess the real incidence of cardiac arrhythmias among COVID-19 patients admitted to Portuguese hospitals and to understand the underlying prognostic implications. Methods The Portuguese Association of Arrhythmology, Pacing and Electrophysiology (APAPE) conducted a survey in Portuguese hospitals to assess the occurrence of arrhythmias in COVID-19 patients, their clinical characteristics, the use of experimental therapies and the impact on QT interval. Results Twenty hospitals participated, reporting 692 hospitalized patients. An arrhythmic episode occurred in 81 (11.7%) and 64 (79%) had detailed information on these episodes. New onset arrhythmias occurred in 41 (64%) patients, 45 (70.3%) male, median age 73.5 (61-80.3) years. There were 51 (79.7%) with associated comorbidities, mainly arterial hypertension (41, 64.1%). Of 53 patients (82.3%) on experimental therapy, 7 (10.9%) had an increased QTc interval. Regarding arrhythmias, two patients (3.1%) had ventricular tachycardia, 5 (7.8%) sinus bradycardia, 17 (26.6%) paroxysmal supraventricular tachycardia and 40 (62.5%) atrial fibrillation or flutter. At the time of reporting, there had been no deaths due to arrhythmic syndrome or related complications. Conclusions In a population of COVID-19 patients. The incidence of cardiac arrhythmias is high but not associated with increased cardiac mortality although it does though occur frequently in extremely ill patients and with multiple organ failure. Regardless of the use of experimental drugs, the incidence of ventricular arrhythmias is low and atrial fibrillation and other supraventricular arrhythmias are the most prevalent arrythmias.

Cardiac Registries During the COVID-19 Pandemic: Lessons Learned

“…Arrhythmias are more frequent in hospitalized patients who are older, male, and critically ill with COVID-19, with an incidence of 11.7 to 21.8% [ 36 , 37 ]. These include sinus bradycardia, paroxysmal supraventricular tachycardia, and tachyarrhythmias—all of which have been associated with increased mortality in patients hospitalized with COVID-19 [ 36 – 40 ].…”

“…Repolarization abnormalities are also predictive of clinical outcomes [ 40 ]. Atrial fibrillation appears to be the most common arrhythmia, accounting for 62.5% of all reported arrhythmias [ 37 ], and is associated with an elevated in-hospital mortality as compared to patients with COVID-19 and no atrial fibrillation [ 36 – 40 ].…”