Predictors and Prognostic Implications of Cardiac Arrhythmias in Patients Hospitalized for COVID-19

Abstract

Background: Cardiac manifestation of COVID-19 has been reported during the COVID pandemic. The role of cardiac arrhythmias in COVID-19 is insufficiently understood. This study assesses the incidence of cardiac arrhythmias and their prognostic implications in hospitalized COVID-19-patients.

Methods: A total of 166 patients from eight centers who were hospitalized for COVID-19 from 03/2020-06/2020 were included. Medical records were systematically analyzed for baseline characteristics, biomarkers, cardiac arrhythmias and clinical outcome parameters related to the index hospitalization. Predisposing risk factors for arrhythmias were identified. Furthermore, the influence of arrhythmia on the course of disease and related outcomes was assessed using univariate and multiple regression analyses.

Results: Arrhythmias were detected in 20.5% of patients. Atrial fibrillation was the most common arrhythmia. Age and cardiovascular disease were predictors for new-onset arrhythmia. Arrhythmia was associated with a pronounced increase in cardiac biomarkers, prolonged hospitalization, and admission to intensive- or intermediate-care-units, mechanical ventilation and in-hospital mortality. In multiple regression analyses, incident arrhythmia was strongly associated with duration of hospitalization and mechanical ventilation. Cardiovascular disease was associated with increased mortality.

Conclusions: Arrhythmia was the most common cardiac event in association with hospitalization for COVID-19. Older age and cardiovascular disease predisposed for arrhythmia during hospitalization. Whereas in-hospital mortality is affected by underlying cardiovascular conditions, arrhythmia during hospitalization for COVID-19 is independently associated with prolonged hospitalization and mechanical ventilation. Thus, incident arrhythmia may indicate a patient subgroup at risk for a severe course of disease.

Keywords: COVID-19; arrhythmia; atrial fibrillation; hospitalization; risk stratification.

Figure 1

Clinical outcome in the overall cohort. Clinical endpoints are depicted as number of cases and percentage in relation to the entire cohort of 166 patients. CPR = cardiopulmonary resuscitation; ECMO = extracorporal membrane oxygenation; HFNC = high flow nasal canula; ICU = intensive care unit; IMC = intermediate care; NIV = non-invasive ventilation.

Figure 2

Arrhythmia diagnoses during hospitalization for COVID-19. (A) Distribution of arrhythmia types in all patients with arrhythmia during hospitalization. (B) Newly-diagnosed arrhythmia types during hospitalization. (C) Newly-diagnosed arrhythmia types in the subgroup of patients without any previous history of arrhythmia. Numbers depicted in the diagram reflect number and proportion of arrhythmia diagnoses. As one patient may have had multiple arrhythmia types, this number does not correspond to group size of patients. AF = atrial fibrillation; PVC = premature ventricular complexes; SVT = supraventricular tachycardia; VF = ventricular fibrillation; VT = ventricular tachycardia.

Figure 3

Receiver operating characteristic curve (ROC) analyses for biomarkers in relation to incident arrhythmia. ROC curves and the corresponding area under the curve (AUC) values were calculated after conducting univariate logistic regression modeling to predict incident arrhythmia for each biomarker, respectively. (A) hsTNT = high-sensitive troponin T; optimal cut-off value according to Youden index analysis: 27.5 pg/mL. (B) NTproBNP = n-terminal pro-B-type natriuretic peptide; cut-off value: 1518 ng/L. (C) CRP = C-reactive protein; cut-off value: 120.5 mg/l. (D) IL-6 = interleukin-6; cut-off value: 82.5 ng/L.