Atrial arrhythmia related outcomes in critically ill COVID‐19 patients

Abstract

Rationale Coronavirus disease 2019 (COVID‐19) is associated with many clinical manifestations including respiratory failure and cardiovascular compromise. Objectives We examine outcomes in critically ill individuals with COVID‐19 who develop atrial tachyarrhythmias. Methods We collected data from electrocardiograms and the electronic medical record of COVID‐19 positive (COVID+) and negative (COVID−) individuals admitted to our medical intensive care unit between February 29 and June 28, 2020. We compared clinical and demographic characteristics, new onset atrial tachyarrhythmia, hemodynamic compromise following atrial tachyarrhythmia, and in‐hospital mortality in COVID+ versus COVID−. Hemodynamic compromise was defined as having a new or increased vasopressor requirement or the need for direct current cardioversion for hemodynamic instability within 1 hour of atrial tachyarrhythmia onset. Results Of 300 individuals included, 200 were COVID+ and 100 were COVID−. Mean age was 60 ± 16 years, 180 (60%) were males, and 170 (57%) were African American. New onset atrial tachyarrhythmia occurred in 16% of COVID+ and 19% of COVID− individuals (P = .51). When compared to COVID− participants without atrial tachyarrhythmia, COVID+ individuals with new onset atrial tachyarrhythmia had higher mortality after multivariable adjustment (OR 5.0, 95% CI 1.9–13.5). New onset atrial tachyarrhythmia was followed by hemodynamic compromise in 18 COVID+ but no COVID− participants (P = .0001). COVID+ individuals with hemodynamic compromise after atrial tachyarrhythmia required increased ventilatory support at the time of atrial tachyarrhythmia onset. Conclusions Atrial tachyarrhythmia is associated with increased mortality in critically ill individuals with COVID‐19, especially those mechanically ventilated. Recognition of this could assist with clinical care for individuals with COVID‐19.

Cardiovascular System during SARS-CoV-2 Infection

“…In paper [56], the authors selected patients with and without CAD to compare these two groups. From six studies with the highest numbers, four were performed in the USA [33,46,56,62] and two in Italy [24,53]. In an article from Pakistan [14], the mean age of patients is lower than in the vast majority of other articles (44.6 ± 15.2).…”

“…In paper [56], the authors selected patients with and without CAD to There are some values that are clearly different from the majority. This may be caused by population heterogeneity, such as higher percentage of male population presented in the study [24,33,53,62], higher age [24,53,56], higher percentage of black race [46,56] or ICU sample [62]. In paper [56], the authors selected patients with and without CAD to compare these two groups.…”

COVID-19: The Impact on Cardiovascular System

“…Arrhythmia in COVID-19 can be secondary to electrolyte imbalance (especially hypokalaemia and hypomagnesemia), pulmonary disease, medication side effects, activated protein kinase C (PKC), or direct oxidized Ca 2+ /calmodulin-dependent protein kinase II (CAMKII) [43]. A recently published study compared COVID-19 ICU patients with ICU patients who were COVID-19 negative and showed that atrial tachyarrhythmia is associated with increased mortality in critically ill patients with COVID-19 (OR 5.0, 95% CI 1.9-13.5) [78]. Interestingly, COVID-19 patients who were mechanically ventilated were more vulnerable to hemodynamic compromise after atrial tachyarrhythmia onset than COVID-19 negative patients.…”

Atrial Arrhythmias During Venovenous ECMO: A Cry for Help?

“…Large studies on the incidence of atrial arrhythmias in critically ill COVID-19 patients (not on VV ECMO) discovered an incidence of approximately 10-16%, though the definitions are not as specific as what was used by Li et al in their work. [9][10][11] It will be of great interest to see if the rate of atrial arrhythmia is similarly high in this growing subset of VV ECMO patients and if the mortality association holds true.…”