Chronic Low-Grade Inflammation: A Possible Link Between COVID-19 and New-Onset Atrial Fibrillation

Area of Science:

• Cardiology
• Immunology
• Infectious Diseases

Background:

• Persistent inflammation and endothelial dysfunction are implicated in post-COVID cardiovascular issues, including atrial fibrillation (AF).
• Understanding these mechanisms is crucial for managing long-term cardiovascular sequelae after SARS-CoV-2 infection.

Purpose of the Study:

• To compare inflammatory/prothrombotic biomarkers and endothelial function between post-COVID patients and controls.
• To investigate the relationship between baseline inflammation/endothelial dysfunction and AF burden at 12 months post-COVID.

Main Methods:

• Retrospective observational study of 198 outpatients (99 post-COVID, 99 controls).
• Baseline assessment included clinical data, inflammatory markers (ESR, CRP, fibrinogen, D-dimer), flow-mediated dilation (FMD), and 24h Holter ECG.
• Follow-up Holter ECG at 12 months; analysis of neutrophil-to-lymphocyte ratio (NLR) quartiles.

Main Results:

• Post-COVID patients had elevated inflammatory markers (ESR, CRP, fibrinogen, D-dimer) and significantly lower FMD compared to controls.
• FMD was inversely associated with inflammatory markers in post-COVID patients (strongest with ESR).
• AF prevalence was numerically higher in post-COVID patients at 12 months and correlated with higher baseline NLR and lower FMD.

Conclusions:

• Post-COVID patients exhibit a persistent inflammatory-prothrombotic state and endothelial dysfunction.
• An inflammation-endothelial dysfunction axis appears linked to increased AF burden in the year following COVID-19.
• Further prospective studies are needed to confirm these findings and explore management strategies.