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Review
. 2023 Dec 9;12(5):236-247.
doi: 10.5492/wjccm.v12.i5.236.

New-onset atrial fibrillation among COVID-19 patients: A narrative review

Fahimeh Talaei  1 , Akshat Banga  2 , Amanda Pursell  3 , Ann Gage  4 , Namratha Pallipamu  5 , Amith Reddy Seri  6 , Ramesh Adhikari  7 , Rahul Kashyap  8   9 , Salim Surani  8   10
Affiliations
Review

New-onset atrial fibrillation among COVID-19 patients: A narrative review

Fahimeh Talaei et al. World J Crit Care Med. .

Abstract

Over the last three years, research has focused on examining cardiac issues arising from coronavirus disease 2019 (COVID-19) infection, including the emergence of new-onset atrial fibrillation (NOAF). Still, no clinical study was conducted on the persistence of this arrhythmia after COVID-19 recovery. Our objective was to compose a narrative review that investigates COVID-19-associated NOAF, emphasizing the evolving pathophysiological mechanisms akin to those suggested for sustaining AF. Given the distinct strategies involved in the persistence of atrial AF and the crucial burden of persistent AF, we aim to underscore the importance of extended follow-up for COVID-19-associated NOAF. A comprehensive search was conducted for articles published between December 2019 and February 11, 2023, focusing on similarities in the pathophysiology of NOAF after COVID-19 and those persisting AF. Also, the latest data on incidence, morbidity-mortality, and management of NOAF in COVID-19 were investigated. Considerable overlaps between the mechanisms of emerging NOAF after COVID-19 infection and persistent AF were observed, mostly involving reactive oxygen pathways. With potential atrial remodeling associated with NOAF in COVID-19 patients, this group of patients might benefit from long-term follow-up and different management. Future cohort studies could help determine long-term outcomes of NOAF after COVID-19.

Keywords: Atrial fibrillation; COVID-19; New-onset atrial fibrillation; SARS-CoV-2.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
Comparing available studies on new-onset atrial fibrillation pathophysiology in coronavirus disease 2019 patients and rotors of atrial fibrillation persistence (including oxidative stress, calcium overload, atrial dilation, micro-RNA, inflammation, and myofibroblast activation. COVID: Coronavirus disease; ECM: Extracellular matrix; NOAF: New-onset atrial fibrillation; AF: Atrial fibrillation; ROS: Reactive oxygen species; ACE2: Angiotensin-converting enzyme-2; ANS: Autonomic nervous system.
Figure 2
Figure 2
Long-term studies needed to assess progression from coronavirus disease 2019-related new-onset atrial fibrillation to more sustained forms of atrial fibrillation. COVID-19: Coronavirus disease 2019; NOAF: New-onset atrial fibrillation; ACE2: Angiotensin-converting enzyme-2; AF: Atrial fibrillation.
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