Electrocardiogram analysis of patients with different types of COVID‐19

Wang, Yina; Chen, Lie; Wang, Jingyi; He, Xingwei; Huang, Fen; Chen, Jing; Yang, Xiaoyun

doi:10.1111/anec.12806

Cited by 64 publications

(82 citation statements)

References 12 publications

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“…After sinus tachycardia, atrial fibrillation ( Fig. 1 ) is the next most commonly seen SVT [ [40] , [41] , [42] ]; atrial fibrillation can present in a number of different fashions, including new-onset, recurrence of a pre-existing dysrhythmia, and persistence of permanent atrial fibrillation with new rapid ventricular response. In the majority of patients with significant COVID-19 infection and atrial fibrillation, the rate will be quite rapid, thus the ECG will demonstrate atrial fibrillation with rapid ventricular response.…”

Section: Discussionmentioning

confidence: 99%

“…In the majority of patients with significant COVID-19 infection and atrial fibrillation, the rate will be quite rapid, thus the ECG will demonstrate atrial fibrillation with rapid ventricular response. Both sinus tachycardia and atrial fibrillation are independent predictors of illness severity, myocardial injury, and poor outcomes in COVID-19 [ 40 ]. One study conducted in New York hospitals found atrial fibrillation/flutter was present in 14.3% of patients at admission and occurred in 10.1% of patients during hospitalization [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

“…One study found ST segment and T wave changes to be the most common abnormality in patients requiring ICU admission, occurring in 40% of patients [ 70 ]. Another investigation noted that nonspecific repolarization changes including ST segment and T wave abnormalities were encountered in 41% of patients; reportedly, these findings resulted from myocardial injury and are associated with poor outcomes, including increased need for ICU admission, more frequent mechanical ventilatory support, and increased mortality [ 32 , 40 ]. A case series included 18 patients with COVID-19 infection and ST segment elevation, 10 of which had ST segment elevation at the time of presentation and 8 developed ST segment elevation during hospitalization [ 71 ].…”

Section: Discussionmentioning

confidence: 99%

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Electrocardiographic manifestations of COVID-19

Long

Brady

Bridwell

et al. 2021

The American Journal of Emergency Medicine

105

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Introduction Coronavirus disease of 2019 (COVID-19) is a lower respiratory tract infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This disease can impact the cardiovascular system and lead to abnormal electrocardiographic (ECG) findings. Emergency clinicians must be aware of the ECG manifestations of COVID-19. Objective This narrative review outlines the pathophysiology and electrocardiographic findings associated with COVID-19. Discussion COVID-19 is a potentially critical illness associated with a variety of ECG abnormalities, with up to 90% of critically ill patients demonstrating at least one abnormality. The ECG abnormalities in COVID-19 may be due to cytokine storm, hypoxic injury, electrolyte abnormalities, plaque rupture, coronary spasm, microthrombi, or direct endothelial or myocardial injury. While sinus tachycardia is the most common abnormality, others include supraventricular tachycardias such as atrial fibrillation or flutter, ventricular arrhythmias such as ventricular tachycardia or fibrillation, various bradycardias, interval and axis changes, and ST segment and T waves changes. Several ECG presentations are associated with poor outcome, including atrial fibrillation, QT interval prolongation, ST segment and T wave changes, and ventricular tachycardia/fibrillation. Conclusions This review summarizes the relevant ECG findings associated with COVID-19. Knowledge of these findings in COVID-19-related electrocardiographic presentations may assist emergency clinicians in the evaluation and management of potentially infected and infected patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Electrocardiographic manifestations of COVID-19

Long

Brady

Bridwell

et al. 2021

The American Journal of Emergency Medicine

105

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“…On the other hand, the incidence of new-onset or paroxysmal AF in COVID-19 is not well known yet. While the rate of new-onset AF/AFL in all AF/AFL cases was above 40% in some studies [ 19 , 20 ], new-onset AF/AFL was not reported among all AF/AFL cases in some other studies [ 11 , 22 ]. New-onset AF was not observed in our cohort during in-hospital follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Similar to the our findings, this study found an independent association between AF or AFL and all-cause mortality [ 20 ]. In addition, another cohort study conclude that AF was the independent risk factor of in-hospital death and ventilator use in patients with COVID-19 [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

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

Özdemir

Özlek

Çetin

2021

Journal of Electrocardiology

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Background Data specifically addressed to whether atrial fibrillation (AF) would contribute to increasing the risk for severe forms of novel coronavirus disease (COVID-19) or worse prognosis remain unclear. Hence, we sought to assess the association of permanent AF with in-hospital outcomes in patients with COVID-19. Methods This was a single-centered, retrospective, observational study including consecutive hospitalized patients with COVID-19. The primary outcome for the study was defined as all cause in-hospital mortality. Clinical characteristics and outcomes of patients with AF were compared to patients without AF. Results Three hundred and fifty hospitalized COVID-19 patients (median age of 55 years, 55.4% men) were enrolled. Of them 40 (11.4%) had AF. Patients with AF were older; were more likely to have co-morbidities, abnormal chest radiography findings and deteriorated laboratory parameters such as D-dimer, troponin, albumin, urea. In-hospital mortality was higher in patients with AF compared to patients without AF (32.5% vs. 13.5%, log-rank p = 0.002, RR 2.40). The number of patients who needed intensive care unit (55% vs. 31%, p = 0.002) and invasive mechanical ventilation (35% vs 15.2%, p = 0.002) were also higher in the AF group. In addition, length of in-hospital stay was longer in patients with AF (median 8 vs. 7 days, p = 0.008). After adjustment for age and co-morbidities, multivariable analyses revealed that AF (HR: 2.426, 95% CI: 1.089–5.405, p = 0.032) was independently associated with in-hospital death. Conclusions AF was seen with together markers of severe COVID-19, and the presence of AF was an independent predictor of in-hospital mortality in patients with COVID-19.

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