Elsevier

JACC: Clinical Electrophysiology

Volume 7, Issue 9, September 2021, Pages 1120-1130
JACC: Clinical Electrophysiology

New Research Paper
Atrial Fibrillation
Atrial Fibrillation in Patients Hospitalized With COVID-19: Incidence, Predictors, Outcomes, and Comparison to Influenza

https://doi.org/10.1016/j.jacep.2021.02.009Get rights and content
Under an Elsevier user license
open archive

Abstract

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.

Key Words

atrial fibrillation
atrial flutter
coronavirus disease-2019
influenza
ischemic stroke

Abbreviations and Acronyms

AF
atrial fibrillation
AFL
atrial flutter
COPD
chronic obstructive pulmonary disease
COVID-19
coronavirus disease-2019
ECG
electrocardiogram
ICD
International Classification of Disease
IL
interleukin
TIA
transient ischemic attack

Cited by (0)

Andrew Epstein, MD, served as Guest Editor for this paper.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.

Drs. Musikantow and Turagam contributed equally to this paper.