New‐onset atrial arrhythmias associated with mortality in black and white patients hospitalized with COVID‐19

Abstract

Background Specific details about cardiovascular complications, especially arrhythmias, related to the coronavirus disease of 2019 (COVID‐19) are not well described. Objective We sought to evaluate the incidence and predictive factors of cardiovascular complications and new‐onset arrhythmias in Black and White hospitalized COVID‐19 patients and determine the impact of new‐onset arrhythmia on outcomes. Methods We collected and analyzed baseline demographic and clinical data from COVID‐19 patients hospitalized at the Tulane Medical Center in New Orleans, Louisiana, between March 1 and May 1, 2020. Results Among 310 hospitalized COVID‐19 patients, the mean age was 61.4 ± 16.5 years, with 58,7% females, and 67% Black patients. Black patients were more likely to be younger, have diabetes and obesity. The incidence of cardiac complications was 20%, with 9% of patients having new‐onset arrhythmia. There was no significant difference in cardiovascular outcomes between Black and White patients. A multivariate analysis determined age ≥60 years to be a predictor of new‐onset arrhythmia (OR = 7.36, 95% CI [1.95;27.76], p = .003). D‐dimer levels positively correlated with cardiac and new‐onset arrhythmic event. New onset atrial arrhythmias predicted in‐hospital mortality (OR = 2.99 95% CI [1.35;6.63], p = .007), a longer intensive care unit length of stay (mean of 6.14 days, 95% CI [2.51;9.77], p = .001) and mechanical ventilation duration(mean of 9.08 days, 95% CI [3.75;14.40], p = .001). Conclusion Our results indicate that new onset atrial arrhythmias are commonly encountered in COVID‐19 patients and can predict in‐hospital mortality. Early elevation in D‐dimer in COVID‐19 patients is a significant predictor of new onset arrhythmias. Our finding suggest continuous rhythm monitoring should be adopted in this patient population during hospitalization to better risk stratify hospitalized patients and prompt earlier intervention.

Cardiovascular System during SARS-CoV-2 Infection

“…There was a visible elevation in arrhythmia prevalence with increasing disease severity demonstrated in 28.6% of critical patients having new arrhythmia (p < 0.001) [42] and in another work, 25.2% of ICU patients [50]. The percentage of SARS-CoV-2-positive patients with both previous and new arrhythmias from previously selected studies [42][43][44][45][46][47] are presented in the next figure (Figure 5). Study [48] was not presented in the figure because it has taken only atrial arrhythmias into account.…”

“…The majority of abnormal arrhythmias were atrial arrhythmias: 89.3% (6.4% from the whole population of 390 patients) [42], 82% (7.4% from the whole population of 310 patients) [46] and 8% from the whole population of 1029 patients [48]. The most common was atrial fibrillation, with the range from 4.3% to 10.4% of COVID-19-positive patients in selected studies presenting with such percentages: 5.4% of 390 [42], 4.3% of 186 [45], 10.4% of 517 [49] and with the range from 62% to 75% amongst the population with arrhythmia in selected studies: 75% [42], 62% [44], 62% [45].…”

“…Arrhythmias, which occurred during hospitalisation, were present with a range between 7.2% and 26.5% of patients. Studies from China, Denmark, Portugal, two from the US and Germany showed the frequency of arrhythmias: 7.2% of 390 patients [42], 11.7% of 692 patients [43], 26.5% of 166 patients [44], 18.3% of 186 [45] and 10% of 310 [46] with the vast majority being atrial fibrillation [42,44,[46][47][48]. A total of 17.6% of 9564 patients had AF during hospitalisation [47], and 8% of 1029 had atrial arrhythmia [48] (these two studies focus only on AF or AA, respectively).…”

“…Completely new-onset arrhythmias happened not so rarely in 5.3% to 13.3% of patients. Presenting with such numbers were: 5.3% (76% AF) of the whole study population [42], 5.9% [43], 13.3% [44], 10.4% (95% AF) [45], 9% (82% atrial arrhythmias) [46] and 11.6% [47]. New-onset atrial arrhythmias in the study of 1029 people involved 4.5% of the whole group of patients [48].…”

A COVID-19 Patient Presenting With Paroxysmal Atrial Fibrillation

“…The pathophysiology of COVID-19-related PAF is not yet fully understood. Proposed mechanisms include viral endothelial damage, reduction in angiotensin-converting enzyme 2 receptor availability, CD147- and sialic acid-spike protein interaction, enhanced inflammatory signaling eventually culminating in an inflammatory cytokine storm, electrolytes and acid-base balance abnormalities, and a substantially increased adrenergic tone [ 12 ].…”