Cardiac arrhythmias in critically ill patients with coronavirus disease 2019: A retrospective population-based cohort
Mik Wetterslev1, Peter Karl Jacobsen2, Christian Hassager2
1Department of Intensive Care, Rigshospitalet University of Copenhagen, Copenhagen, Denmark.
Insights
New-onset cardiac arrhythmias, particularly supraventricular, were common in intensive care unit patients with coronavirus disease 2019 (COVID-19). These arrhythmias were linked to higher disease severity and increased 60-day mortality, despite interventions.
Area of Science:
- Critical Care Medicine
- Cardiology
- Infectious Diseases
Background:
- Limited data exist on cardiac arrhythmias in intensive care unit (ICU) patients with coronavirus disease 2019 (COVID-19).
- Understanding arrhythmia epidemiology in this population is crucial for patient management.
Purpose of the Study:
- To describe the incidence and characteristics of cardiac arrhythmias in ICU patients diagnosed with COVID-19.
- To identify risk factors and outcomes associated with cardiac arrhythmias in this cohort.
Main Methods:
- A multicenter, retrospective cohort study was conducted.
- Included were 155 ICU patients with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests.
- Data on cardiac arrhythmias, risk factors, interventions, and outcomes were collected.
Main Results:
- The incidence of cardiac arrhythmias was 37%, with 68% being new-onset.
- Tachyarrhythmia history and higher disease severity were associated with arrhythmias.
- Patients with arrhythmias had a significantly higher 60-day mortality (63%) compared to those without (39%).
Conclusions:
- New-onset supraventricular arrhythmias are frequent in critically ill COVID-19 patients.
- Arrhythmias are associated with prior tachyarrhythmia history and acute disease severity.
- High mortality persists in COVID-19 patients with ICU-acquired arrhythmias despite interventions.
Background:
Coronavirus disease 2019 (COVID-19) may be associated with cardiac arrhythmias in hospitalized patients, but data from the ICU setting are limited. We aimed to describe the epidemiology of cardiac arrhythmias in ICU patients with COVID-19.
Methods:
We conducted a multicenter, retrospective cohort study including all ICU patients with an airway sample positive for severe acute respiratory syndrome corona-virus 2 from March 1st to June 1st in the Capital Region of Denmark (1.8 million inhabitants). We registered cardiac arrhythmias in ICU, potential risk factors, interventions used in ICU and outcomes.
Results:
From the seven ICUs we included 155 patients with COVID-19. The incidence of cardiac arrhythmias in the ICU was 57/155 (37%, 95% confidence interval 30-45), and 39/57 (68%) of these patients had this as new-onset arrhythmia. Previous history of tachyarrhythmias and higher disease severity at ICU admission were associated with cardiac arrhythmias in the adjusted analysis. Fifty-four of the 57 (95%) patients had supraventricular origin of the arrhythmia, 39/57 (68%) received at least one intervention against arrhythmia (eg amiodarone, IV fluid or magnesium) and 38/57 (67%) had recurrent episodes of arrhythmia in ICU. Patients with arrhythmias in ICU had higher 60-day mortality (63%) as compared to those without arrhythmias (39%).
Conclusion:
New-onset supraventricular arrhythmias were frequent in ICU patients with COVID-19 and were related to previous history of tachyarrhythmias and severity of the acute disease. The mortality was high in these patients despite the frequent use of interventions against arrhythmias.
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