COVID-19 associated atrial fibrillation: Incidence, putative mechanisms and potential clinical implications

Abstract

Coronavirus disease 2019 (COVID-19) is a novel, highly transmittable and severe strain disease, which has rapidly spread worldwide. Despite epidemiological evidence linking COVID-19 with cardiovascular diseases, little is known about whether and how COVID-19 influences atrial fibrillation (AF), the most prevalent arrhythmia in clinical practice. Here, we review the available evidence for prevalence and incidence of AF in patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and discuss disease management approaches and potential treatment options for COVID-19 infected AF patients.

Keywords: Anticoagulation; Arrhythmia; Inflammasome; Remote monitoring; Thromboembolic risk.

Fig. 1

Putative mechanisms of AF in COVID-19 patients. Infection by SARS-CoV-2, facilitated by TMPRSS2, is manifested by the progression of immune cell over-activation leading to “cytokine storm”, ACE2 internalization and loss of both ACE2-mediated cardiovascular protection and fluid-electrolyte homeostasis, atrial structural changes via CD147- and sialic acid-spike protein, and hypoxemia. Subsequently, all abovementioned mechanisms result in myocardial injury and remodelling, sympathetic nervous system activation that coupled with electrolytes and fluids disturbances lead to conduction system disorder, hence atrial fibrillation susceptibility.

Fig. 2

Flowchart of acute AF management in COVID-19 patients.