Frequency of Atrial Arrhythmia in Hospitalized Patients With COVID-19

Yarmohammadi, Hirad; Morrow, John; Dizon, José; Biviano, Angelo; Ehlert, Frederick; Saluja, Deepak; Waase, Marc; Elias, Pierre; Poterucha, Timothy J.; Berman, Jeremy; Kushnir, Alexander; Abrams, Mark P.; Rubin, Geoffrey; Jou, Stephanie; Hennessey, Jessica A.; Uriel, Nir; Wan, Elaine; Garan, Hasan

doi:10.1016/j.amjcard.2021.01.039

Cited by 13 publications

(27 citation statements)

References 33 publications

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“…However, no reference is made on possible secondary conditions and the timing of arrhythmia occurrence. Increased in ammatory markers and vasopressor need were reported during AF appearance, without specifying whether AF occurrence was coincidental to a secondary infection episode [2,9]. Other studies con rm the increased NOAF incidence in ICU Covid-19 patients, varying between 16.5-40%, yet, without specifying whether the virus or other factors, frequently present in critically-ill patients, are associated to its occurrence [9,10,11,[13][14][15][37][38][39].…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, existing data lack information about the exact time of NOAF appearance in the course of Covid-19 [10,11,13,14,[37][38][39]]. An early, in the course of the infection, virally driven hyperin ammation-cytokine storm has been proposed as a possible mechanism, partially explaining NOAF occurrence in patients hospitalized in the wards [2,9]. In our study, NOAF appeared late in the course of the disease, approximately during the 18th post symptom onset day (8th ICU day), when COVID-19 symptoms usually subside [39].…”

Section: Discussionmentioning

confidence: 99%

“…Increased in ammatory markers and vasopressor need were reported during AF appearance, without specifying whether AF occurrence was coincidental to a secondary infection episode [2,9]. Other studies con rm the increased NOAF incidence in ICU Covid-19 patients, varying between 16.5-40%, yet, without specifying whether the virus or other factors, frequently present in critically-ill patients, are associated to its occurrence [9,10,11,[13][14][15][37][38][39]. Similarly, existing data lack information about the exact time of NOAF appearance in the course of Covid-19 [10,11,13,14,[37][38][39]].…”

Section: Discussionmentioning

confidence: 99%

“…Cardiac arrhythmias, mainly atrial brillation (AF), are not uncommon in COVID-19 patients [9][10][11].…”

mentioning

confidence: 99%

“…Studies do not clearly report on the exact time that NOAF appeared [9,10,[13][14][15]. However, NOAF is far more frequent in Intensive Care Unit (ICU) patients compared to patients in the ward [9,10,[13][14][15]. Therefore, as respiratory worsening occurs after several days from symptom onset, AF seems to occur late in the course of the disease, when the patients have been admitted in the ICU [1,13,14].…”

mentioning

confidence: 99%

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Secondary bacterial infections trigger New Onset Atrial Fibrillation in ICU Covid-19 ARDS patients

Zakynthinos¹,

Tsolaki²,

Karavidas³

et al. 2021

Preprint

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Background Cardiac arrhythmias, mainly atrial fibrillation (AF), is frequently reported in COVID-19 patients, yet causality has not been explored. Intensive Care Unit patients frequently present AF during critical illness. Sepsis is one of the main contributors of AF occurrence in ICU patients. The aim of the study was to explore if Covid-19 myocardial involvement is the only contributor for New Onset Atrial Fibrillation (NOAF) in intubated ICU patients. Methods Consecutive intubated, Covid-19ARDS patients, were prospectively studied for factors triggering NOAF. Demographics, data on Covid-19 infection duration, severity of illness and ARDS are reported. Echocardiographic findings, troponin levels and secondary infection (sepsis/septic shock) data were collected on the day of AF and compared to the preceding days’ and/or ICU admission data. Comparison was also performed between NOAF and control group (no AF) on admission. Results Among 105 patients screened, 79 were eligible; nineteen presented NOAF (24%). Baseline characteristics did not differ between the NOAF and control groups. Troponin levels were mildly elevated upon ICU admission in both groups. NOAF occurred on the 18 ± 4.8 days from Covid-19 symptoms’ onset, and the 8.5 ± 2.1 ICU day. Seventeen patients in the NOAF group (89.5%) presented a septic secondary infection vs 25 (41.6%) in the control group (p < 0.001). In sixteen NOAF patients (84.2%), AF occurred concurrently with a secondary septic episode. Noradrenaline, lactate levels and inflammation biomarkers presented a gradual increase in the days preceding the AF day (all p < 0.05). Troponin increased compared to admission (p = 0.017). AF did not resolve or re-occurred if sepsis persisted. Upon ICU admission left ventricular ejection fraction was rather normal, yet, global longitudinal strain was equally impaired (< 16.5%) in 63% vs 78% in the NOAF and control groups, respectively. The right ventricle was mildly dilated, and 36 (45.6%) patients had pericardial effusion. Echocardiographic findings did not change on NOAF occurrence. Conclusion Secondary infections seem to be major contributors for NOAF in Covid-19 patients, probably playing the role of the “second hit” in an affected myocardium from Covid-19.

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