Arrhythmias and Intraventricular Conduction Disturbances in Patients Hospitalized With Coronavirus Disease 2019
Nishi H Patel1, Josh Rutland2, Kristen M Tecson2
1WellSpan Health, York Hospital, York, Pennsylvania.
Insights
New cardiac arrhythmias in hospitalized COVID-19 patients are linked to higher mortality and ICU admission. Conduction disturbances were less common and did not impact outcomes, suggesting arrhythmias reflect disease severity.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Cardiac arrhythmias are reported in COVID-19 patients.
- Previous studies often included sinus tachycardia, potentially masking true cardiac dysfunction.
- Limited data exist on conduction disturbances in COVID-19.
Purpose of the Study:
- To compare outcomes of COVID-19 patients with and without new arrhythmias (excluding sinus tachycardia).
- To compare outcomes of COVID-19 patients with and without new conduction disturbances.
- To clarify the relationship between cardiac rhythm/conduction issues and COVID-19 severity.
Main Methods:
- Retrospective review of hospitalized COVID-19 patients.
- Comparison of characteristics and outcomes between groups with and without incident arrhythmias.
- Comparison of characteristics and outcomes between groups with and without incident conduction disturbances.
Main Results:
- 16% of patients developed new arrhythmias; these were associated with increased ICU admission, intubation, and death.
- New arrhythmias were not linked to decompensated heart failure.
- 8% developed new conduction disturbances, which were not associated with adverse outcomes.
Conclusions:
- Incident arrhythmias in COVID-19 are associated with increased mortality, reflecting disease severity rather than intrinsic cardiac dysfunction.
- Conduction disturbances are less frequent and not linked to adverse outcomes.
- Excluding sinus tachycardia provides a clearer picture of cardiac involvement in severe COVID-19.
Abstract:
Cardiac arrhythmias have been observed in patients hospitalized with coronavirus disease (COVID-19). Most analyses of rhythm disturbances to date include cases of sinus tachycardia, which may not accurately reflect true cardiac dysfunction. Furthermore, limited data exist regarding the development of conduction disturbances in patients hospitalized with COVID-19. Hence, we performed a retrospective review and compared characteristics and outcomes for patients with versus without incident arrhythmia, excluding sinus tachycardia, as well as between those with versus without incident conduction disturbances. There were 27 of 173 patients (16%) hospitalized with COVID-19 who developed a new arrhythmia. Incident arrhythmias were associated with an increased risk of intensive care unit admission (59% vs 31%, p = 0.0045), intubation (56% vs 20%, p <0.0001), and inpatient death (41% vs 10%, p = 0.0002) without an associated increase in risk of decompensated heart failure or other cardiac issues. New conduction disturbances were found in 13 patients (8%). Incident arrhythmias in patients hospitalized with COVID-19 are associated with an increased risk of mortality, likely reflective of underlying COVID-19 disease severity more than intrinsic cardiac dysfunction. Conduction disturbances occurred less commonly and were not associated with adverse patient outcomes.
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