Atrial Fibrillation in Patients Hospitalized With COVID-19

Quick Takes

  • AF/Fl occurs in 10-12% of inpatients with COVID-19 and influenza and is not more common in COVID-19 patients.
  • The AF/Fl reflects a generalized response to severe viral illness.
  • AF/Fl during hospitalization for COVID-19 and influenza is associated with an approximately 75% higher risk of death.

Study Questions:

Is coronavirus disease 2019 (COVID-19) associated with a higher incidence of atrial fibrillation/flutter (AF/Fl) than influenza?

Methods:

This was a multicenter, retrospective cohort study of patients with laboratory-confirmed COVID-19 admitted to five hospitals in New York City during the COVID-19 pandemic. These patients were compared to patients hospitalized because of influenza.

Results:

There were 3,970 patients with COVID-19 (mean age, 66 years) and 1,420 patients with influenza (mean age, 67 years). The incidence of AF/Fl was lower in the COVID-19 group than in the influenza group (10% vs. 12%, respectively). New-onset AF occurred in 4% of both groups of patients. AF/Fl during the hospitalization was associated with approximately a 75% higher risk of mortality. Patients with AF/Fl were older than those without AF/Fl (median age, 74 vs. 66 years) and more often had hypertension (56% vs. 32%), diabetes (33% vs. 24%), and heart failure (25% vs. 5%). Inflammatory markers such as interleukin-6 were higher in the patients with AF/Fl (93 vs. 68 pg/ml). AF/Fl also was associated with more myocardial injury (mean troponin-I concentration, 0.2 vs. 0.06 ng/ml).

Conclusions:

AF/Fl is not more common in hospitalized COVID-19 patients than in patients with influenza and is associated with approximately a 75% higher risk of death in both groups. AF/Fl is associated with age, comorbidities, inflammation, and myocardial injury and reflects a generalized response to viral illnesses.

Perspective:

COVID-19 is associated with an increased risk of myocardial injury and myocarditis. Inflammation or injury in the atria can predispose to AF/Fl. The results of this study indicate that this does not occur to a greater extent in COVID-19 patients than in patients with influenza. As is the case in patients with many types of severe illness, AF/Fl in patients with COVID-19 and influenza is associated with higher mortality. However, there is no evidence that suppression of AF/Fl during hospitalization reduces the risk of mortality.

Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Hypertension

Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Atrial Flutter, Coronavirus, COVID-19, Critical Illness, Diabetes Mellitus, Heart Failure, Hypertension, Inflammation, Influenza, Human, Interleukin-6, Myocarditis, Secondary Prevention, Troponin I


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