Elsevier

Heart Rhythm

Volume 17, Issue 9, September 2020, Pages 1439-1444
Heart Rhythm

Clinical
General
COVID-19 and cardiac arrhythmias

https://doi.org/10.1016/j.hrthm.2020.06.016Get rights and content

Background

Early studies suggest that coronavirus disease 2019 (COVID-19) is associated with a high incidence of cardiac arrhythmias. Severe acute respiratory syndrome coronavirus 2 infection may cause injury to cardiac myocytes and increase arrhythmia risk.

Objectives

The purpose of this study was to evaluate the risk of cardiac arrest and arrhythmias including incident atrial fibrillation (AF), bradyarrhythmias, and nonsustained ventricular tachycardia (NSVT) in a large urban population hospitalized for COVID-19. We also evaluated correlations between the presence of these arrhythmias and mortality.

Methods

We reviewed the characteristics of all patients with COVID-19 admitted to our center over a 9-week period. Throughout hospitalization, we evaluated the incidence of cardiac arrests, arrhythmias, and inpatient mortality. We also used logistic regression to evaluate age, sex, race, body mass index, prevalent cardiovascular disease, diabetes, hypertension, chronic kidney disease, and intensive care unit (ICU) status as potential risk factors for each arrhythmia.

Results

Among 700 patients (mean age 50 ± 18 years; 45% men; 71% African American; 11% received ICU care), there were 9 cardiac arrests, 25 incident AF events, 9 clinically significant bradyarrhythmias, and 10 NSVTs. All cardiac arrests occurred in patients admitted to the ICU. In addition, admission to the ICU was associated with incident AF (odds ratio [OR] 4.68; 95% confidence interval [CI] 1.66–13.18) and NSVT (OR 8.92; 95% CI 1.73–46.06) after multivariable adjustment. Also, age and incident AF (OR 1.05; 95% CI 1.02–1.09) and prevalent heart failure and bradyarrhythmias (OR 9.75; 95% CI 1.95–48.65) were independently associated. Only cardiac arrests were associated with acute in-hospital mortality.

Conclusion

Cardiac arrests and arrhythmias are likely the consequence of systemic illness and not solely the direct effects of COVID-19 infection.

Keywords

Atrial fibrillation
Arrhythmia
Cardiac arrest
COVID-19
Mortality
Nonsustained ventricular tachycardia

Cited by (0)

Partial support for this project was provided by the Winkelman Family Fund in Cardiovascular Innovation.

1

These authors contributed equally.

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