Incident Atrial Fibrillation and In-Hospital Mortality in SARS-CoV-2 Patients

Abstract

(1) Background: Among the different cardiovascular (CV) manifestations of the coronavirus disease 2019 (COVID-19), arrhythmia and atrial fibrillation (AF) in particular have recently received special attention. The aims of our study were to estimate the incidence of AF in patients hospitalized for COVID-19, and to evaluate its role as a possible predictor of in-hospital all-cause mortality. (2) Methods: We enrolled 3435 people with SARS-CoV2 infection admitted to three hospitals in Northern Italy from February 2020 to May 2021. We collected data on their clinical history, laboratory tests, pharmacological treatment and intensive care unit (ICU) admission. Incident AF and all-cause in-hospital mortality were considered as outcomes. (3) Results: 145 (4.2%) patients developed AF during hospitalization, with a median time since admission of 3 days (I-III quartile: 0, 12). Patients with incident AF were admitted more frequently to the ICU (39.3 vs. 12.4%, p < 0.001), and more frequently died (37.2 vs. 16.9%, p < 0.001). In the Cox regression model, the significant determinants of incident AF were age (HR: 1.041; 95% CI: 1.022, 1.060 per year), a history of AF (HR: 2.720; 95% CI: 1.508, 4.907), lymphocyte count (HR: 0.584; 95% CI: 0.384, 0.888 per 103/µL), estimated glomerular filtration rate (eGFR, HR: 0.988; 95% CI: 0.980, 0.996 per mL/min) and ICU admission (HR: 5.311; 95% CI: 3.397, 8.302). Incident AF was a predictor of all-cause mortality (HR: 1.405; 95% CI: 1.027, 1.992) along with age (HR: 1.057; 95% CI: 1.047, 1.067), male gender (HR: 1.315; 95% CI: 1.064; 1.626), dementia (HR: 1.373; 95% CI: 1.045, 1.803), lower platelet (HR: 0.997; 95% CI: 0.996, 0.998 per 103/µL) and lymphocyte counts (HR: 0.843; 95% CI: 0.725, 0.982 per 103/µL), C-Reactive protein values (HR: 1.004; 95% CI: 1.003, 1.005 per mg/L), eGFR (HR: 0.990; 95% CI: 0.986, 0.994 per mL/min), and ICU admission (HR: 1.759; 95% CI: 1.292, 2.395). (4) Conclusions: Incident AF is a common complication in COVID-19 patients during hospitalization, and its occurrence strongly predicts in-hospital mortality.

A systematic review and meta‐analysis of new‐onset atrial fibrillation in the context of COVID‐19 infection

“…After considering the title and abstract, 663 articles were eliminated, leaving 72 papers that were regarded as plausible for this analysis. Following review of these studies based on the inclusion and exclusion criteria, 30 articles totaling 81 929 COVID‐19 patients were eventually included in this meta‐analysis 5–7,10–36 . Table 1 summarizes the baseline characteristics of the included studies.…”

Predictors and Clinical Significance of Myocardial Injury in Elderly Patients Under the COVID-19 Pandemic

“…The prevalence of arrhythmia could also increase the risk of myocardial injury and poor prognosis. 25 These etiologies would have an exaggerated detrimental effect on older patients compared with other populations. In this sense, the presence of myocardial injury should alert physicians to cautious assessment.…”

The potential role of SARS‐CoV‐2 infection in acute coronary syndrome and type 2 myocardial infarction (T2MI): Intertwining spread

“…The blocking of the hERG channel prolongs QT intervals on ECG; thus, it might induce severe ventricular arrhythmias and even sudden cardiac death 149 . Notably, long‐term use of lopinavir/ritonavir in HIV‐1 patients was not associated with an increased risk for MI 150 …”

“…149 Notably, long-term use of lopinavir/ritonavir in HIV-1 patients was not associated with an increased risk for MI. 150 Antibiotic azithromycin was elected to be effective against SARS-CoV-2 infection and is regarded as a potential proarrhythmogenic agent associated with cardiovascular death through QT prolongation. 151 Azithromycin in combination with hydroxychloroquine increase the risk of developing ventricular arrhythmia as both drugs have torsadogenic potential.…”