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Published on: February 26, 2013
Atrial Fibrillation in Patients Hospitalized With COVID-19: Incidence, Predictors, Outcomes, and Comparison to
Daniel R Musikantow1, Mohit K Turagam1, Samantha Sartori1
1Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Insights
Atrial fibrillation and flutter occurred in 10% of COVID-19 patients, linked to inflammation and higher mortality. These arrhythmias are a generalized response to severe viral illness, not specific to coronavirus disease-2019.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Coronavirus disease-2019 (COVID-19) is associated with elevated inflammatory markers linked to atrial arrhythmias.
- The incidence, specificity, and outcomes of atrial fibrillation (AF) and atrial flutter (AFL) in COVID-19 patients remain largely unknown.
Purpose of the Study:
- To investigate the incidence, predictors, and outcomes of AF/AFL in hospitalized patients with COVID-19.
- To compare these findings with patients hospitalized for influenza.
Main Methods:
- Retrospective analysis of 3,970 patients with PCR-positive COVID-19.
- Comparator group included 1,420 patients hospitalized with influenza.
- Manual review of 1,110 COVID-19 cases for detailed analysis.
Main Results:
- The incidence of AF/AFL in COVID-19 patients was 10% (4% new-onset).
- New-onset AF/AFL was associated with older age, increased inflammatory markers (IL-6), and myocardial injury.
- AF/AFL correlated with increased mortality in both COVID-19 (46% vs. 26%) and influenza (12% incidence, similar mortality risk).
Conclusions:
- AF/AFL occurs in a subset of patients with severe viral illnesses like COVID-19 and influenza.
- These arrhythmias are associated with systemic inflammation and disease severity.
- The findings suggest AF/AFL is a generalized response to severe viral infections, not specific to COVID-19.
Objectives:
The goal of this study is to determine the incidence, predictors, and outcomes of atrial fibrillation (AF) or atrial flutter (AFL) in patients hospitalized with coronavirus disease-2019 (COVID-19).
Background:
COVID-19 results in increased inflammatory markers previously associated with atrial arrhythmias. However, little is known about their incidence or specificity in COVID-19 or their association with outcomes.
Methods:
This is a retrospective analysis of 3,970 patients admitted with polymerase chain reaction-positive COVID-19 between February 4 and April 22, 2020, with manual review performed of 1,110. The comparator arm included 1,420 patients with influenza hospitalized between January 1, 2017, and January 1, 2020.
Results:
Among 3,970 inpatients with COVID-19, the incidence of AF/AFL was 10% (n = 375) and in patients without a history of atrial arrhythmias it was 4% (n = 146). Patients with new-onset AF/AFL were older with increased inflammatory markers including interleukin 6 (93 vs. 68 pg/ml; p < 0.01), and more myocardial injury (troponin-I: 0.2 vs. 0.06 ng/ml; p < 0.01). AF and AFL were associated with increased mortality (46% vs. 26%; p < 0.01). Manual review captured a somewhat higher incidence of AF/AFL (13%, n = 140). Compared to inpatients with COVID-19, patients with influenza (n = 1,420) had similar rates of AF/AFL (12%, n = 163) but lower mortality. The presence of AF/AFL correlated with similarly increased mortality in both COVID-19 (relative risk: 1.77) and influenza (relative risk: 1.78).
Conclusions:
AF/AFL occurs in a subset of patients hospitalized with either COVID-19 or influenza and is associated with inflammation and disease severity in both infections. The incidence and associated increase in mortality in both cohorts suggests that AF/AFL is not specific to COVID-19, but is rather a generalized response to the systemic inflammation of severe viral illnesses.
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