COVID-19 and Cardiac Arrhythmias

Quick Takes

  • Incident AF, clinically significant bradycardia, and nonsustained ventricular tachycardia were not associated with mortality in COVID-19 patients.
  • Cardiac arrests were mostly due to nonshockable rhythms such as pulseless electrical activity arrest or asystole, and only one event was due to torsades de pointes.

Study Questions:

What is the risk of cardiac arrest and incident atrial fibrillation (AF), bradyarrhythmias, and nonsustained ventricular tachycardia (NSVT) in a large urban population hospitalized for coronavirus disease 2019 (COVID-19), and what is the relationship between the arrhythmia and mortality?

Methods:

Characteristics of all COVID-19 patients admitted to a single center were reviewed, with particular attention to the incidence of cardiac arrests, arrhythmias, and in-patient mortality.

Results:

A total of 700 patients (mean age 50 years, 45% men, 71% African American, and 11% intensive care unit [ICU] care) experienced nine cardiac arrests, 25 incident AF events, nine clinically significant bradyarrhythmias, and 10 NSVTs. All cardiac arrests occurred among patients admitted to the ICU. Admission to the ICU was associated with incident AF and NSVT after multivariable adjustment. Thirty patients (4%) died during hospitalization; cardiac arrests were associated with acute, in-hospital mortality, but the other arrhythmias were not.

Conclusions:

Cardiac arrests and arrhythmias are likely the consequence of systemic illness and not solely the direct effects of COVID-19 infection on the myocardium.

Perspective:

The present study shows the catastrophic toll of COVID-19 on hospitalized patients. Only ICU patients experienced cardiac arrests. Among the four arrhythmias (incident AF, bradyarrhythmia, NSVT, and cardiac arrest) only cardiac arrest was associated with in-hospital mortality. Nearly all of the cardiac arrests included nonshockable rhythms such as pulseless electrical activity or asystole, with only one patient experiencing torsades de pointes. Twenty-five percent of patients were on hydroxychloroquine and none were on azithromycin; the incidence of torsades was smaller than in prior reports. The presented findings support the notion that direct myocardial infarction or necrosis were not the main drivers of mortality, rather systemic infection and inflammation were to blame.

Clinical Topics: Arrhythmias and Clinical EP, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Novel Agents, Statins

Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Bradycardia, Coronavirus, COVID-19, Heart Arrest, Hospital Mortality, Hydroxychloroquine, Inflammation, Intensive Care Units, Myocardium, Secondary Prevention, Tachycardia, Ventricular, Torsades de Pointes


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