Clinical characteristics and prognosis of hospitalized COVID‐19 patients with incident sustained tachyarrhythmias: A multicenter observational study

Abstract

Introduction: Little is still known about the prognostic impact of incident arrhythmias in hospitalized patients with COVID-19. The aim of this study was to evaluate the incidence and predictors of sustained tachyarrhythmias in hospitalized patients with COVID-19, and their potential association with disease severity and in-hospital mortality. Materials and methods: This was a retrospective multicenter observation study including consecutive patients with laboratory confirmed COVID-19 admitted to emergency department of ten Italian Hospitals from 15 February to 15 March 2020. The prevalence and the type of incident sustained arrhythmias have been collected. The correlation between the most prevalent arrhythmias and both baseline characteristics and the development of ARDS and in-hospital mortality has been evaluated. Results: 414 hospitalized patients with COVID-19 (66.9 ± 15.0 years, 61.1% male) were included in the present study. During a median follow-up of 28 days (IQR: 12-45), the most frequent incident sustained arrhythmia was AF (N: 71; 17.1%), of which 50 (12.1%) were new-onset and 21 (5.1%) were recurrent, followed by VT (N: 14, 3.4%) and supraventricular arrhythmias (N: 5, 1.2%). Incident AF, both new-onset and recurrent, did not affect the risk of severe adverse events including ARDS and death during hospitalization; in contrast, incident VT significantly increased the risk of in-hospital mortality (RR: 2.55; P: .003). Conclusions: AF is the more frequent incident tachyarrhythmia; however, it not seems associated to ARDS development and death. On the other hand, incident VT is a not frequent but independent predictor of in-hospital mortality among hospitalized COVID-19 patients.

Cardiovascular Comorbidities and Pharmacological Treatments of COVID-19 Patients Not Requiring Hospitalization

“…A low prevalence of coexisting cardiovascular comorbidities, such as coronary artery disease, chronic kidney disease and atrial fibrillation, accounting for less than 4%, has been reported among COVID-19 patients not requiring hospitalization, which is different than those reported by cohort studies in hospital settings (ranging from 5 to 17%) [ 2 , 12 , 13 ]. This finding might be explained by the recommendation to refer COVID-19 patients with a low ischemic threshold related to underlying cardiovascular disease, who were at increased risk to develop myocardial injury or a clinically severe form of the disease and death [ 14 ], to emergency departments.…”

Permanent atrial fibrillation portends poor outcomes in hospitalized patients with COVID-19: A retrospective observational study

“…However, the incidence and nature of atrial arrhythmias among patients with SARS-CoV-2 was poorly documented. Newly published studies suggest that the most frequent incident sustained arrhythmia is AF in the hospitalized COVID-19 population [ 18 ]. Abrams et al retrospectively described clinical characteristics and compared factors contributing toward arrhythmic versus non-arrhythmic death in patients with COVID-19 [ 19 ].…”

“…In a series of 414 patients hospitalized with COVID-19, Russo et al studied potential association of sustained tachyarrhythmias with disease severity and in-hospital death. The results of this study suggest that AF was not associated with mortality [ 18 ]. Elias et al analyzed 1258 patients and identified only 42 incident AF or AFL events.…”

“…A limited number of studies revealed that COVID-19 patients with AF were older and most of them had at least one preexisting risk factor, including hypertension, CAD, CHF, renal disease, prior stroke or pulmonary disease [ 18 , 20 , 27 ], while some did not report any illness [ 28 ]. COVID-19 patients with comorbid diseases, such as CHF, hypertension, CAD, DM and RF, have an extremely poor prognosis, compared with subjects without co-morbidities [ 13 , 26 ].…”

Association of atrial fibrillation and left atrial volume index with mortality in patients with COVID-19 pneumonia

“…Arrhythmias are complex and multifactorial in a COVID-19 patient and may result from metabolic derangements, hypoxia, acidosis, intravascular volume imbalances, neurohormonal, and catecholaminergic stress. 4 , 5 Sepsis is characterized by a systemic process involving inflammatory cytokines and autonomic dysfunction. Postulated mechanisms of this arrhythmogenesis include autonomic nervous system-induced calcium entry into cardiac myocytes, spontaneous release of calcium from the sarcoplasmic reticulum, 6 as well as possible direct LA injury due to coronary artery disease with small vessel thrombosis.…”