COVID-19 and cardiac arrhythmias

Abstract

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

Graphical abstract

Figure 1

Arrhythmic events by intensive care unit (ICU) status. The number of cardiac arrests and arrhythmias are depicted in the entire cohort of patients with coronavirus disease 2019 (dark blue), those admitted to the ICU (light blue), and those admitted to a non-ICU ward (orange). NSVT = nonsustained ventricular tachycardia.

Figure 2

Association of intensive care unit (ICU) status and cardiac arrhythmias. The odds ratios (and 95% confidence intervals) of ICU admission and specified cardiac arrhythmias are depicted. The dashed vertical red line represents an odds ratio = 1. Unadjusted models have a blue marker. Multivariable models (black marker) were adjusted for age, sex, race, body mass index, heart failure, coronary heart disease, diabetes, hypertension, chronic kidney disease, and hydroxychloroquine treatment. NSVT = nonsustained ventricular tachycardia.

Figure 3

Cardiac arrhythmias and death. The percentage of deceased and alive patients in each arrhythmia category is depicted. NSVT = nonsustained ventricular tachycardia.