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Observational Study
. 2020 Dec;31(12):3077-3085.
doi: 10.1111/jce.14770. Epub 2020 Oct 14.

Outcomes and mortality associated with atrial arrhythmias among patients hospitalized with COVID-19

Bradley Peltzer  1 , Kevin K Manocha  1 , Xiaohan Ying  1 , Jared Kirzner  1 , James E Ip  1 , George Thomas  1 , Christopher F Liu  1 , Steven M Markowitz  1 , Bruce B Lerman  1 , Monika M Safford  2 , Parag Goyal  1 , Jim W Cheung  1
Affiliations
Observational Study

Outcomes and mortality associated with atrial arrhythmias among patients hospitalized with COVID-19

Bradley Peltzer et al. J Cardiovasc Electrophysiol. 2020 Dec.

Abstract

Introduction: The impact of atrial arrhythmias on coronavirus disease 2019 (COVID-19)-associated outcomes are unclear. We sought to identify prevalence, risk factors and outcomes associated with atrial arrhythmias among patients hospitalized with COVID-19.

Methods: An observational cohort study of 1053 patients with severe acute respiratory syndrome coronavirus 2 infection admitted to a quaternary care hospital and a community hospital was conducted. Data from electrocardiographic and telemetry were collected to identify atrial fibrillation (AF) or atrial flutter/tachycardia (AFL). The association between atrial arrhythmias and 30-day mortality was assessed with multivariable analysis.

Results: Mean age of patients was 62 ± 17 years and 62% were men. Atrial arrhythmias were identified in 166 (15.8%) patients, with AF in 154 (14.6%) patients and AFL in 40 (3.8%) patients. Newly detected atrial arrhythmias occurred in 101 (9.6%) patients. Age, male sex, prior AF, renal disease, and hypoxia on presentation were independently associated with AF/AFL occurrence. Compared with patients without AF/AFL, patients with AF/AFL had significantly higher levels of troponin, B-type natriuretic peptide, C-reactive protein, ferritin and d-dimer. Mortality was significantly higher among patients with AF/AFL (39.2%) compared to patients without (13.4%; p < .001). After adjustment for age and co-morbidities, AF/AFL (adjusted odds ratio [OR]: 1.93; p = .007) and newly detected AF/AFL (adjusted OR: 2.87; p < .001) were independently associated with 30-day mortality.

Conclusion: Atrial arrhythmias are common among patients hospitalized with COVID-19. The presence of AF/AFL tracked with markers of inflammation and cardiac injury. Atrial arrhythmias were independently associated with increased mortality.

Keywords: COVID-19; atrial fibrillation; atrial flutter; mortality; outcomes.

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Figures

Figure 1
Figure 1
Newly detected atrial fibrillation in a patient with coronavirus disease 2019 (COVID‐19). A 76‐year‐old female admitted with hypoxia and COVID‐19 developed atrial fibrillation with rapid ventricular response (top strip: V1 electrocardiogram) on hospital day 2 and was treated with amiodarone and digoxin. She then developed respiratory failure requiring mechanical ventilation. On hospital day 17, in the setting of potassium level of 2.2 mEq/ml and digoxin level of 0.62 ng/ml, she had ventricular bigeminy and torsade de pointes with prolonged QT interval (bottom strip: telemetry). Time course of treatments are shown.
Figure 2
Figure 2
Biomarker levels among patients with and without atrial fibrillation/atrial flutter (AFL) during hospitalization for COVID‐19. Bar graphs comparing mean peak levels of (A) cardiac troponin I, (B) C‐reactive protein, (C) B‐type natriuretic peptide, (D) d ‐dimer, (E) erythrocyte sedimentation rate, (F) ferritin are shown. Error bars indicate 95% confidence intervals for mean. p < .001 for all comparisons. COVID‐19, coronavirus disease 2019
Figure 3
Figure 3
Survival among hospitalized COVID‐19 patients stratified by presence of atrial fibrillation and AFL. (A) Kaplan–Meier survival curves of patients with and without any atrial fibrillation or AFL. (B) Kaplan–Meier survival curves of patients with and without newly detected AFL. AFL, atrial flutter; COVID‐19, coronavirus disease 2019
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References

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