Atrial arrhythmia related outcomes in critically ill COVID-19 patients
Chad M Colon1, James G Barrios1, Joe W Chiles2
1Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Insights
Critically ill patients with Coronavirus disease 2019 (COVID-19) experiencing atrial tachyarrhythmias face higher mortality. This heart rhythm complication, particularly in mechanically ventilated patients, requires prompt recognition for improved clinical management.
Area of Science:
- Critical Care Medicine
- Cardiology
- Infectious Diseases
Background:
- Coronavirus disease 2019 (COVID-19) presents with diverse clinical issues, including respiratory and cardiovascular compromise.
- Atrial tachyarrhythmias are a recognized complication in critically ill patients.
Purpose of the Study:
- To investigate the outcomes of critically ill patients with COVID-19 who develop atrial tachyarrhythmias.
- To compare the incidence of atrial tachyarrhythmias and associated complications between COVID-19 positive and negative patients.
Main Methods:
- Retrospective analysis of electrocardiogram and electronic medical record data from critically ill patients (COVID-19 positive and negative).
- Comparison of demographic characteristics, new-onset atrial tachyarrhythmia, hemodynamic compromise, and in-hospital mortality.
- Hemodynamic compromise defined by vasopressor use or cardioversion for instability within 1 hour of arrhythmia onset.
Main Results:
- New-onset atrial tachyarrhythmia occurred in 16% of COVID-19 positive and 19% of COVID-19 negative patients.
- COVID-19 positive patients with atrial tachyarrhythmia showed significantly higher mortality (OR 5.0) compared to COVID-19 negative patients without the arrhythmia.
- Hemodynamic compromise followed atrial tachyarrhythmia in 18% of COVID-19 positive patients but none of the COVID-19 negative patients, necessitating increased ventilatory support.
Conclusions:
- Atrial tachyarrhythmia is linked to increased mortality in critically ill COVID-19 patients, particularly those on mechanical ventilation.
- Early identification and management of atrial tachyarrhythmias in COVID-19 patients are crucial for improving clinical outcomes.
- Understanding this association can guide therapeutic strategies and resource allocation in managing severe COVID-19 cases.
Rationale:
Coronavirus disease 2019 (COVID-19) is associated with many clinical manifestations including respiratory failure and cardiovascular compromise.
Objectives:
We examine outcomes in critically ill individuals with COVID-19 who develop atrial tachyarrhythmias.
Methods:
We collected data from electrocardiograms and the electronic medical record of COVID-19 positive (COVID+ ) and negative (COVID- ) individuals admitted to our medical intensive care unit between February 29 and June 28, 2020. We compared clinical and demographic characteristics, new onset atrial tachyarrhythmia, hemodynamic compromise following atrial tachyarrhythmia, and in-hospital mortality in COVID+ versus COVID- . Hemodynamic compromise was defined as having a new or increased vasopressor requirement or the need for direct current cardioversion for hemodynamic instability within 1 hour of atrial tachyarrhythmia onset.
Results:
Of 300 individuals included, 200 were COVID+ and 100 were COVID- . Mean age was 60 ± 16 years, 180 (60%) were males, and 170 (57%) were African American. New onset atrial tachyarrhythmia occurred in 16% of COVID+ and 19% of COVID- individuals (P = .51). When compared to COVID- participants without atrial tachyarrhythmia, COVID+ individuals with new onset atrial tachyarrhythmia had higher mortality after multivariable adjustment (OR 5.0, 95% CI 1.9-13.5). New onset atrial tachyarrhythmia was followed by hemodynamic compromise in 18 COVID+ but no COVID- participants (P = .0001). COVID+ individuals with hemodynamic compromise after atrial tachyarrhythmia required increased ventilatory support at the time of atrial tachyarrhythmia onset.
Conclusions:
Atrial tachyarrhythmia is associated with increased mortality in critically ill individuals with COVID-19, especially those mechanically ventilated. Recognition of this could assist with clinical care for individuals with COVID-19.
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