Cardiac arrhythmias in patients with COVID-19: Lessons from 2300 telemetric monitoring days on the intensive care unit

Abstract

Background Patients with COVID-19 seem to be prone to the development of arrhythmias. The objective of this trial was to determine the characteristics, clinical significance and therapeutic consequences of these arrhythmias in COVID-19 patients requiring intensive care unit (ICU) treatment. Methods and results A total of 113 consecutive patients (mean age 64.1 ± 14.3 years, 30 (26.5%) female) with positive PCR testing for SARS-CoV2 as well as radiographically confirmed pulmonary involvement admitted to the ICU from March to May 2020 were included and observed for a cumulative time of 2321 days. Fifty episodes of sustained atrial tachycardias, five episodes of sustained ventricular arrhythmias and thirty bradycardic events were documented. Sustained new onset atrial arrhythmias were associated with hemodynamic deterioration in 13 cases (35.1%). Patients with new onset atrial arrhythmias were older, showed higher levels of Hs-Troponin and NT-proBNP, and a more severe course of disease. The 5 ventricular arrhythmias (two ventricular tachycardias, two episodes of ventricular fibrillation, and one torsade de pointes tachycardia) were observed in 4 patients. All episodes could be terminated by immediate defibrillation/cardioversion. Five bradycardic events were associated with hemodynamic deterioration. Precipitating factors could be identified in 19 of 30 episodes (63.3%), no patient required cardiac pacing. Baseline characteristics were not significantly different between patients with or without bradycardic events. Conclusion Relevant arrhythmias are common in severely ill ICU patients with COVID-19. They are associated with worse courses of disease and require specific treatment. This makes daily close monitoring of telemetric data mandatory in this patient group.

The Prevalence and Associated Death of Ventricular Arrhythmia and Sudden Cardiac Death in Hospitalized Patients With COVID-19: A Systematic Review and Meta-Analysis

“…Twenty-one studies , which included 13,790 hospitalized patients with COVID-19 with a mean age ranging from 50 to 70.3 years, and with sample sizes ranging from 54 to 4,526, were published from 2020 to 2021 [eight of them published in 2021 (11,15,16,19,(24)(25)(26)31), others in 2020 (12-14, 17, 18, 20-23, 27-30)]. Nine reports were from Asia [eight from China (13,16,18,21,22,28,29,31), one from Iran (19)], seven from USA (11,12,14,15,17,25,30), and five from Europe [three from Italy (20,24,27), one from Netherland (23), one from Germany (26)]. Besides, 15 of them were retrospective studies (11, 13, 15-19, 21-23, 27-31), 5 were prospective studies (12,14,20,25,26), and 1 was cross-section study (24).…”

“…Nine reports were from Asia [eight from China (13,16,18,21,22,28,29,31), one from Iran (19)], seven from USA (11,12,14,15,17,25,30), and five from Europe [three from Italy (20,24,27), one from Netherland (23), one from Germany (26)]. Besides, 15 of them were retrospective studies (11, 13, 15-19, 21-23, 27-31), 5 were prospective studies (12,14,20,25,26), and 1 was cross-section study (24).…”

“…A total of 20 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) studies with 13,509 patients reported the prevalence of ventricular arrhythmia in patients with COVID-19. As shown in Figure 2, the pooled prevalence of the ventricular arrhythmia was 5% (95% CI: 4-6%).…”

Myocarditis and Cardiac Complications Associated With COVID-19 and mRNA Vaccination: A Pragmatic Narrative Review to Guide Clinical Practice

“…The vast majority (82%) are benign, consisting of transient atrial fibrillation, atrial flutter, and supraventricular tachycardia [ 44 ]. Life-threatening arrhythmias, such as ventricular tachycardia and ventricular fibrillation, are uncommon (4-6%) [ 15 ] but are predictably associated with the severity of illness and with elevated cardiac biomarkers and LV dysfunction [ 15 , [44] , [45] , [46] ]. Most life-threatening arrhythmias occur in critically unwell patients on mechanical ventilation, or with haemodynamic or biochemical derangement [ 44 ].…”

The impact of Covid‐19 on cardiovascular health

“…Whilst arrhythmia prevalence is not uncommon in hospitalized Covid‐19 patients, this frequency increases in those requiring intensive care. In one observational study of 113 intensive care patients in Germany, 34 the authors report that 44.2% of patients experienced sustained atrial arrhythmia, the most common of which (35%) was atrial fibrillation. Sustained ventricular tachycardia, ventricular fibrillation or Torsade's de Pointes were observed in 4 patients (3.5%), whilst 10 patients (8.9%) experienced second or third‐degree atrioventricular block.…”