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Atrial fibrillation burden during the coronavirus disease 2019 pandemic

Catherine J O'Shea1,2, Melissa E Middeldorp1,2, Gijo Thomas1

  • 1Centre for Heart Rhythm Disorders, University of Adelaide, North Terrace, Adelaide, South Australia, 5000, Australia.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|June 2, 2021
PubMed

Insights

The COVID-19 pandemic was associated with a 33% increase in atrial fibrillation (AF) episodes in patients with cardiac implantable electronic devices (CIEDs). Higher COVID-19 prevalence correlated with more AF occurrences, suggesting pandemic-related social disruptions may play a role.

Area of Science:

  • Cardiology
  • Epidemiology
  • Public Health

Background:

  • The coronavirus disease 2019 (COVID-19) pandemic introduced unprecedented social and healthcare disruptions.
  • Atrial fibrillation (AF) is a common arrhythmia, and its occurrence can be influenced by various physiological and environmental stressors.
  • Patients with cardiac implantable electronic devices (CIEDs) offer a unique population for monitoring AF episodes remotely.

Purpose of the Study:

  • To investigate the association between the COVID-19 pandemic and the occurrence of AF in patients with CIEDs.
  • To compare AF burden during the pandemic with a historical control period.
  • To examine the relationship between AF occurrence and state-level COVID-19 prevalence.

Main Methods:

  • A multi-center, observational cohort study was conducted over 100 days during the COVID-19 pandemic in the USA.
  • Remote monitoring of 10,346 CIEDs (pacemakers or defibrillators) with atrial leads was utilized.
  • AF episodes (≥6 minutes) were compared to an identical 100-day period in 2019 (Control) and analyzed against per-state COVID-19 prevalence.

Main Results:

  • A significant increase in AF episodes was observed during the COVID-19 pandemic compared to the control period (Incident Rate Ratio [IRR] 1.33).
  • AF episodes lasting ≥1 hour (IRR 1.65) and ≥6 hours (IRR 1.54) also showed significant increases.
  • A higher proportion of patients experienced AF episodes in states with high COVID-19 prevalence compared to low prevalence states (Odds Ratio 1.34).

Conclusions:

  • The COVID-19 pandemic was associated with a 33% increase in AF episodes among patients with CIEDs.
  • A 34% increase in the proportion of patients experiencing AF episodes was noted in high COVID-19 prevalence states.
  • Findings suggest a potential link between pandemic-related social disruptions and AF occurrence in CIED patients.
Abstract

Keywords:
Atrial fibrillationCardiac implantable electronic deviceCoronavirusCoronavirus disease 2019DefibrillatorPacemaker

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