COVID-19 and cardiac arrhythmias

Abstract

BACKGROUND Early studies suggest that coronavirus disease 2019 (COVID-19) is associated with a high incidence of cardiac arrhythmias. Severe acute respiratory syndrome coronavirus 2 infection may cause injury to cardiac myocytes and increase arrhythmia risk.OBJECTIVES The purpose of this study was to evaluate the risk of cardiac arrest and arrhythmias including incident atrial fibrillation (AF), bradyarrhythmias, and nonsustained ventricular tachycardia (NSVT) in a large urban population hospitalized for COVID-19. We also evaluated correlations between the presence of these arrhythmias and mortality.METHODS We reviewed the characteristics of all patients with COVID-19 admitted to our center over a 9-week period. Throughout hospitalization, we evaluated the incidence of cardiac arrests, arrhythmias, and inpatient mortality. We also used logistic regression to evaluate age, sex, race, body mass index, prevalent cardiovascular disease, diabetes, hypertension, chronic kidney disease, and intensive care unit (ICU) status as potential risk factors for each arrhythmia.RESULTS Among 700 patients (mean age 50 6 18 years; 45% men; 71% African American; 11% received ICU care), there were 9 cardiac arrests, 25 incident AF events, 9 clinically significant bradyarrhythmias, and 10 NSVTs. All cardiac arrests occurred in patients admitted to the ICU. In addition, admission to the ICU was associated with incident AF (odds ratio [OR] 4.68; 95% confidence interval [CI] 1.66-13.18) and NSVT (OR 8.92; 95% CI 1.73-46.06) after multivariable adjustment. Also, age and incident AF (OR 1.05; 95% CI 1.02-1.09) and prevalent heart failure and bradyarrhythmias (OR 9.75; 95% CI 1.95-48.65) were independently associated. Only cardiac arrests were associated with acute in-hospital mortality.CONCLUSION Cardiac arrests and arrhythmias are likely the consequence of systemic illness and not solely the direct effects of COVID-19 infection.

Out-of-hospital cardiac arrest treated by emergency medical service teams during COVID-19 pandemic: A retrospective cohort study

“…In the corresponding period of 2019, it was 19.5% for ROSC and 13.2% for transport with ongoing CPR respectively. Pranata et al [23] suggest that the COVID-19 pandemic was associated with higher OHCA-related mortality.…”

“…The numbers might be even higher in developing countries due to poor healthcare and emergency medical service systems [23]. In turn Bhatla et al [20] indicated that cardiac arrests and arrhythmias are likely the consequence of systemic illness and not solely the direct effects of COVID-19 infection [24].…”

Prognostic Impact of Prior Heart Failure in Patients Hospitalized With COVID-19

“…Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), is a rapidly expanding pandemic associated with overwhelming morbidity and mortality across the globe ( 1 ). History of cardiovascular disease has repeatedly been associated with worse prognosis ( 2 , 3 ), whereas de novo cardiovascular involvement in its various forms, from myocardial injury to myocarditis and shock, has also been amply described ( 4 , 5 , 6 , 7 ). Among patients hospitalized with COVID-19, patients with heart failure (HF) represent a population at the highest potential risk for complications due to a high prevalence of underlying frailty or renal dysfunction among other comorbidities ( 8 ).…”

Cardiac Arrhythmias in Critically Ill Patients With COVID-19: A Brief Review

“…7 Bhatla et al reported a 7.5% overall incidence of arrhythmias, of which 43% occurred in the patients who were admitted to the ICU. 8 The higher likelihood of serious disease and ICU admissions among older patients with comorbidities, the hyperinflammatory response, and myocardial injury associated with SARS-CoV-2 infection, as well as the use of arrhythmogenic agents to target COVID-19, such as anti-malarial or antiviral medications, all contribute to a heightened risk of arrhythmias, which creates unique challenges for critical care providers.…”