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. 2021 Sep;7(9):1120-1130.
doi: 10.1016/j.jacep.2021.02.009. Epub 2021 Feb 24.

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

Daniel R Musikantow  1 , Mohit K Turagam  1 , Samantha Sartori  1 , Edward Chu  1 , Iwanari Kawamura  1 , Poojita Shivamurthy  1 , Mahmoud Bokhari  1 , Connor Oates  1 , Chi Zhang  1 , Christopher Pumill  1 , Waqas Malick  1 , Helen Hashemi  1 , Tania Ruiz-Maya  1 , Michael B Hadley  1 , Jonathan Gandhi  1 , Dylan Sperling  1 , William Whang  2 , Jacob S Koruth  2 , Marie-Noelle Langan  2 , Aamir Sofi  2 , Anthony Gomes  2 , Stephanie Harcum  2 , Sam Cammack  2 , Betsy Ellsworth  2 , Srinivas R Dukkipati  2 , Adel Bassily-Marcus  3 , Roopa Kohli-Seth  3 , Martin E Goldman  1 , Jonathan L Halperin  1 , Valentin Fuster  1 , Vivek Y Reddy  4
Affiliations

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

Daniel R Musikantow et al. JACC Clin Electrophysiol. 2021 Sep.

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.

Keywords: atrial fibrillation; atrial flutter; coronavirus disease-2019; influenza; ischemic stroke.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Koruth has received consulting fees from Abbott Laboratories, CardioFocus, Farapulse, and Vytron US, Inc. Dr Dukkipati has received grant support from Biosense Webster; and has equity with Farapulse and Manual Surgical Sciences, LLC. Dr Halperin has received consulting fees from Boehringer Ingelheim, Johnson & Johnson-Janssen Pharmaceuticals, and Medtronic. Dr Reddy is a consultant with Abbott, Ablacon, Acutus Medical, Affera, Apama Medical, Aquaheart, Atacor, Autonomix, Axon, Backbeat, BioSig, Biosense Webster, Biotronik, Boston Scientific, Cardiofocus, Cardionomic, CardioNXT/AFTx, Circa Scientific, Corvia Medical, Dinova-Hangzhou Nuomao Medtech Co., Ltd., East End Medical, EBR, EPD, Epix Therapeutics, EpiEP, Eximo, Fire1, Impulse Dynamics, Javelin, Kardium, Keystone Heart, LuxCath, Manual Surgical Sciences, Medlumics, Medtronic, Middlepeak, Newpace, Nuvera, Philips, Pulse Biosciences, Sirona Medical, Stimda, Surecor, Thermedical, and Valcare; and has equity in Ablacon, Acutus Medical, Affera, Apama, Aquaheart, Atacor, Autonomix, Backbeat, BioSig, Circa Scientific, Corvia Medical, Dinova-Hangzhou Nuomao Medtech Co., Ltd., East End Medical, EPD, Epix Therapeutics, EpiEP, Eximo, Fire 1, Javelin, Kardium, Keystone Heart, LuxCath, Manual Surgical Sciences, Medlumics, Middlepeak, Newpace, Nuvera, Sirona Medical, Surecor, Valcare, and Vizaramed. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Survival Stratified by AF/AFL in COVID-19 Versus Influenza Survival estimates based on the days since hospital admission stratified by COVID-19 versus influenza status as well as the occurrence of in-hospital or new-onset atrial fibrillation. For the purpose of this analysis, patients discharged from the hospital were considered to have survived. AF = atrial fibrillation; COVID = coronavirus disease.
Central Illustration
Central Illustration
Incidence, Predictors, and Outcomes of Atrial Arrhythmias in Patients Admitted With COVID-19 Versus Influenza AF = atrial fibrillation; AFL = atrial flutter; COVID-19 = coronavirus disease-2019; RR = relative risk.
See this image and copyright information in PMC

Comment in

  • Atrial Arrhythmias and the Pandemic.
    Chinitz LA. Chinitz LA. JACC Clin Electrophysiol. 2021 Sep;7(9):1131-1133. doi: 10.1016/j.jacep.2021.03.011. JACC Clin Electrophysiol. 2021. PMID: 34556286 Free PMC article. No abstract available.
  • COVID-19 and AF: What About the Long Game?
    Vadakken ME, Belley-Cote EP, McIntyre WF. Vadakken ME, et al. JACC Clin Electrophysiol. 2021 Sep;7(9):1196-1197. doi: 10.1016/j.jacep.2021.05.018. JACC Clin Electrophysiol. 2021. PMID: 34556288 Free PMC article. No abstract available.

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