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

Gawałko, Monika; Kapłon‐Cieślicka, Agnieszka; Hohl, Mathias; Dobrev, Dobromir; Linz, Dominik

doi:10.1016/j.ijcha.2020.100631

Cited by 133 publications

(177 citation statements)

References 93 publications

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“…A limited number of studies revealed that COVID-19 patients with AF were older and most of them had at least one preexisting risk factor, including hypertension, CAD, CHF, renal disease, prior stroke or pulmonary disease [ 18 , 20 , 27 ], while some did not report any illness [ 28 ]. COVID-19 patients with comorbid diseases, such as CHF, hypertension, CAD, DM and RF, have an extremely poor prognosis, compared with subjects without co-morbidities [ 13 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Permanent atrial fibrillation portends poor outcomes in hospitalized patients with COVID-19: A retrospective observational study

Özdemir

Özlek

Çetin

2021

Journal of Electrocardiology

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Background Data specifically addressed to whether atrial fibrillation (AF) would contribute to increasing the risk for severe forms of novel coronavirus disease (COVID-19) or worse prognosis remain unclear. Hence, we sought to assess the association of permanent AF with in-hospital outcomes in patients with COVID-19. Methods This was a single-centered, retrospective, observational study including consecutive hospitalized patients with COVID-19. The primary outcome for the study was defined as all cause in-hospital mortality. Clinical characteristics and outcomes of patients with AF were compared to patients without AF. Results Three hundred and fifty hospitalized COVID-19 patients (median age of 55 years, 55.4% men) were enrolled. Of them 40 (11.4%) had AF. Patients with AF were older; were more likely to have co-morbidities, abnormal chest radiography findings and deteriorated laboratory parameters such as D-dimer, troponin, albumin, urea. In-hospital mortality was higher in patients with AF compared to patients without AF (32.5% vs. 13.5%, log-rank p = 0.002, RR 2.40). The number of patients who needed intensive care unit (55% vs. 31%, p = 0.002) and invasive mechanical ventilation (35% vs 15.2%, p = 0.002) were also higher in the AF group. In addition, length of in-hospital stay was longer in patients with AF (median 8 vs. 7 days, p = 0.008). After adjustment for age and co-morbidities, multivariable analyses revealed that AF (HR: 2.426, 95% CI: 1.089–5.405, p = 0.032) was independently associated with in-hospital death. Conclusions AF was seen with together markers of severe COVID-19, and the presence of AF was an independent predictor of in-hospital mortality in patients with COVID-19.

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Section: Discussionmentioning

confidence: 99%

Permanent atrial fibrillation portends poor outcomes in hospitalized patients with COVID-19: A retrospective observational study

Özdemir

Özlek

Çetin

2021

Journal of Electrocardiology

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“…Other contributing factors (which may cause ventricular arrhythmias as well) include immune-mediated injury caused by inflammatory cytokines, which can prolong the action-potential duration by interacting with potassium and calcium channels, and myocardial ischemia due to virus-mediated vasculitis, viral myocarditis, or underlying coronary atherosclerosis. 7 Ventricular arrhythmias can be mediated by all of the above, but the “off-label” use of some agents with known arrhythmic potential is of particular concern, especially in the absence of any proven benefit. Chief among these medications are hydroxychloroquine, chloroquine, and azithromycin, all of which prolong the QT interval by interacting with the hERG potassium channel and can precipitate torsades de pointes when used individually or in combination.…”

Section: Cardiac Arrhythmiasmentioning

confidence: 99%

Arrhythmias in the Age of Coronavirus Disease 2019

Niazi¹,

Khan²

2021

J Innov Cardiac Rhythm Manage.

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“…However, the use of therapeutic anticoagulation may occur as a result of many reported complications of COVID-19 including venous thromboembolism, arterial thromboembolism, cardiac arrhythmia, and disseminated intravascular coagulation. [51][52][53][54][55][56][57][58] We surmised that an intensification of anticoagulation indicated an adverse change in clinical condition. Third, this study was conducted on Veterans currently receiving care in the VA, who are older and have a higher prevalence of chronic health conditions and risk behaviors than the general US population.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Early initiation of prophylactic anticoagulation for prevention of COVID-19 mortality: a nationwide cohort study of hospitalized patients in the United States

Rentsch

Beckman

Tomlinson

et al. 2020

Preprint

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ImportanceDeaths among patients with coronavirus disease 2019 (COVID-19) are partially attributed to venous thromboembolism and arterial thromboses. Anticoagulants prevent thrombosis formation, possess anti-inflammatory and anti-viral properties, and may be particularly effective for treating patients with COVID-19.ObjectiveTo evaluate whether initiation of prophylactic anticoagulation within 24 hours of admission is associated with decreased risk of death among patients hospitalized with COVID-19.DesignObservational cohort study.SettingNationwide cohort of patients receiving care in the Department of Veterans Affairs, the largest integrated healthcare system in the United States.ParticipantsAll patients hospitalized with laboratory-confirmed SARS-CoV-2 infection March 1 to July 31, 2020, without a history of therapeutic anticoagulation.ExposuresProphylactic doses of subcutaneous heparin, low-molecular-weight heparin, or direct oral anticoagulants.Main Outcomes and Measures30-day mortality. Secondary outcomes: inpatient mortality and initiating therapeutic anticoagulation.ResultsOf 4,297 patients hospitalized with COVID-19, 3,627 (84.4%) received prophylactic anticoagulation within 24 hours of admission. More than 99% (n=3,600) received subcutaneous heparin or enoxaparin. We observed 622 deaths within 30 days of admission, 513 among those who received prophylactic anticoagulation. Most deaths (510/622, 82%) occurred during hospitalization. In inverse probability of treatment weighted analyses, cumulative adjusted incidence of mortality at 30 days was 14.3% (95% CI 13.1-15.5) among those receiving prophylactic anticoagulation and 18.7% (95% CI 15.1-22.9) among those who did not. Compared to patients who did not receive prophylactic anticoagulation, those who did had a 27% decreased risk for 30-day mortality (HR 0.73, 95% CI 0.66-0.81). Similar associations were found for inpatient mortality and initiating therapeutic anticoagulation. Quantitative bias analysis demonstrated that results were robust to unmeasured confounding (e-value lower 95% CI 1.77). Results persisted in a number of sensitivity analyses.Conclusions and RelevanceEarly initiation of prophylactic anticoagulation among patients hospitalized with COVID-19 was associated with a decreased risk of mortality. These findings provide strong real-world evidence to support guidelines recommending the use of prophylactic anticoagulation as initial therapy for COVID-19 patients upon hospital admission.

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

Cited by 133 publications

References 93 publications

Permanent atrial fibrillation portends poor outcomes in hospitalized patients with COVID-19: A retrospective observational study

Permanent atrial fibrillation portends poor outcomes in hospitalized patients with COVID-19: A retrospective observational study

Arrhythmias in the Age of Coronavirus Disease 2019

Early initiation of prophylactic anticoagulation for prevention of COVID-19 mortality: a nationwide cohort study of hospitalized patients in the United States

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