COVID-19 and cardiac arrhythmias
Anjali Bhatla1, Michael M Mayer1, Srinath Adusumalli1
1Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Insights
COVID-19 patients hospitalized with severe illness face increased risks of cardiac arrest and arrhythmias like atrial fibrillation. These events are often linked to the systemic impact of critical illness rather than direct viral effects.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- COVID-19 is linked to a higher incidence of cardiac arrhythmias.
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may damage heart cells, increasing arrhythmia risk.
Purpose of the Study:
- To assess the risk of cardiac arrest and arrhythmias (atrial fibrillation, bradyarrhythmias, nonsustained ventricular tachycardia) in hospitalized COVID-19 patients.
- To examine the relationship between these arrhythmias and mortality.
Main Methods:
- Retrospective review of 700 patients hospitalized with COVID-19 over 9 weeks.
- Evaluation of cardiac arrests, arrhythmias, and inpatient mortality.
- Logistic regression analysis to identify risk factors including ICU status, age, and comorbidities.
Main Results:
- 9 cardiac arrests, 25 incident atrial fibrillation, 9 bradyarrhythmias, and 10 nonsustained ventricular tachycardias occurred.
- Intensive care unit (ICU) admission was associated with incident atrial fibrillation and nonsustained ventricular tachycardia.
- Age and incident atrial fibrillation, and heart failure and bradyarrhythmias were independently associated. Only cardiac arrests correlated with mortality.
Conclusions:
- Cardiac arrests and arrhythmias in COVID-19 patients are likely multifactorial, stemming from systemic illness.
- The findings suggest that critical illness severity, not solely direct viral impact, contributes to cardiac complications.
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 ± 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.
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