Cardiac arrhythmias in hospitalized patients with COVID-19: A prospective observational study in the western United States

Abstract

Arrhythmias have been reported frequently in COVID-19 patients, but the incidence and nature have not been well characterized. Patients admitted with COVID-19 and monitored by telemetry were prospectively enrolled in the study. Baseline characteristics, hospital course, treatment and complications were collected from the patients’ medical records. Telemetry was monitored to detect the incidence of cardiac arrhythmias. The incidence and types of cardiac arrhythmias were analyzed and compared between survivors and non-survivors. Among 143 patients admitted with telemetry monitoring, overall in-hospital mortality was 25.2% (36/143 patients) during the period of observation (mean follow-up 23.7 days). Survivors were less tachycardic on initial presentation (heart rate 90.6 ± 19.6 vs. 99.3 ± 23.1 bpm, p = 0.030) and had lower troponin (peak troponin 0.03 vs. 0.18 ng/ml. p = 0.004), C-reactive protein (peak C-reactive protein 97 vs. 181 mg/dl, p = 0.029), and interleukin-6 levels (peak interleukin-6 30 vs. 246 pg/ml, p = 0.003). Sinus tachycardia, the most common arrhythmia (detected in 39.9% [57/143] of patients), occurred more frequently in non-survivors (58.3% vs. 33.6% in survivors, p = 0.009). Premature ventricular complexes occurred in 28.7% (41/143), and non-sustained ventricular tachycardia in 15.4% (22/143) of patients, with no difference between survivors and non-survivors. Sustained ventricular tachycardia and ventricular fibrillation were not frequent (seen only in 1.4% and 0.7% of patients, respectively). Contrary to reports from other regions, overall mortality was higher and ventricular arrhythmias were infrequent in this hospitalized and monitored COVID-19 population. Either disease or management-related factors could explain this divergence of clinical outcomes, and should be urgently investigated.

Demographic, clinical, electrocardiographic and echocardiographic characteristics of patients hospitalized with COVID-19 and cardiac disease at a tertiary hospital, South Africa

“…Sinus tachycardia is a common response to systemic infection or inflammation. In contrast to the study by Shi (15). In a minority of cases, we noted sinus bradycardia.…”

Prevalence of and factors associated with COVID-19 diagnosis in symptomatic patients followed in general practices in Germany between March 2020 and March 2021

“…In terms of comorbidities, COVID-19 diagnosis was strongly and positively associated with cardiac arrhythmias, depression and obesity. A substantial body of literature has suggested that cardiac arrhythmias are relatively common in people with COVID-19 (Cho et al, 2020;Gopinathannair et al, 2020;Rav-Acha et al, 2021). One study of 390 hospitalized COVID-19 patients from Israel showed that 7.2% of them had arrhythmias (e.g., tachyarrhythmias or bradyarrhythmias) (Rav-Acha et al, 2021).…”

Patterns of oxygen saturation in prolonged recovery from COVID-19 pneumonia

“…• We often noted a persistent tachycardia [4] of >100/min for which there was no obvious cause other than recovery from the pneumonia.…”