Coronavirus Disease and New-Onset Atrial Fibrillation: Two Cases

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has resulted in a considerable amount of morbidity and mortality worldwide since December 2019. Patients with coronavirus disease (COVID-19) most commonly present with respiratory manifestations, while cardiac manifestations were reported as a complication and seldom as a presenting feature. We report two cases of new-onset atrial fibrillation occurring in middle-aged men with no significant past medical history. The first patient presented with symptomatic atrial fibrillation; however, during his hospitalization course, he developed a fever, which led to the diagnosis of infection with SARS-CoV-2. The second patient presented from urgent care after being diagnosed with COVID-19 associated with newly diagnosed atrial fibrillation. Both patients were treated symptomatically for COVID-19 and discharged home after reverting to sinus rhythm. Physicians should be aware of the variable clinical presentations of COVID-19, especially in new or worsening cardiac illnesses, in order to practice the appropriate personal protection practices. More studies are needed to identify the viral mechanisms leading to the dysregulation of cardiac rhythm.

COVID-19 associated atrial fibrillation: Incidence, putative mechanisms and potential clinical implications

“…However, reliable data regarding first-diagnosed AF in patients with COVID-19 are limited. Based on case reports [19] , [20] and small clinical studies [21] , [22] , [23] , [24] , new-onset AF varies between 3.6% and 6.7% in patients with COVID-19.…”

“…While atrial structural remodeling is important in providing the AF-maintaining substrate, AF onset and its paroxysms are often temporally related to acute COVID-19 infections. Of note, COVID-19 patients developing AF were older and most of them had at least one preexisting risk factor, including hypertension [19] , [23] , while some did not report any illness. [19] , [20] , [27] Older age and occurrence of heart failure were also associated with greater likelihood of incident AF during the COVID-19 infection [21] .…”

“…Of note, COVID-19 patients developing AF were older and most of them had at least one preexisting risk factor, including hypertension [19] , [23] , while some did not report any illness. [19] , [20] , [27] Older age and occurrence of heart failure were also associated with greater likelihood of incident AF during the COVID-19 infection [21] . Therefore, COVID-19 patients with newly diagnosed AF may have a preexisting substrate for AF and the acute COVID-19 infection may provide the trigger for AF initiation, which is consistent with the temporal relationship between new-onset AF and the COVID-19 infection.…”

A Case of Isolated Dysarthria in a COVID-19 Infected Stroke Patient: A Nondisabling Neurological Symptom With Grave Prognosis

“…AF is the most common arrhythmia noted among elderly individuals [ 17 ]. Although, earlier new onset AF is rare [ 18 ], it helps predict disease severity and mortality [ 16 , 18 ].…”

Disrupting the Electrical Circuit: New Onset Atrial Fibrillation in a Patient With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)

“…The prevalence of arrhythmias and conduction system disease in patients with COVID-19 varies from population to population [4]. Several case reports have shown that onset of atrial fibrillation may vary from a few days up to a week from acquiring the infection; however, sometimes may be longer [5,6]. Regarding the mechanism, hypoxia and electrolyte abnormalities, both known to contribute to the development of acute arrhythmias, have been frequently reported in the acute phase of COVID-19 illness [4].…”