• Anjali Bhatla, Michael M Mayer, Srinath Adusumalli, Matthew C Hyman, Eric Oh, Ann Tierney, Juwann Moss, Anwar A Chahal, George Anesi, Srinivas Denduluri, Christopher M Domenico, Jeffrey Arkles, Benjamin S Abella, John R Bullinga, David J Callans, Sanjay Dixit, Andrew E Epstein, David S Frankel, Fermin C Garcia, Ramanan Kumareswaram, Saman Nazarian, Michael P Riley, Pasquale Santangeli, Robert D Schaller, Gregory E Supple, David Lin, Francis Marchlinski, and Rajat Deo.
• Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
• Heart Rhythm. 2020 Sep 1; 17 (9): 1439-1444.

BackgroundEarly studies suggest that coronavirus disease 2019 (COVID-19) is associated with a high incidence of cardiac arrhythmias. Severe acute respiratory syndrome coronavirus 2 infection may cause injury to cardiac myocytes and increase arrhythmia risk.ObjectivesThe purpose of this study was to evaluate the risk of cardiac arrest and arrhythmias including incident atrial fibrillation (AF), bradyarrhythmias, and nonsustained ventricular tachycardia (NSVT) in a large urban population hospitalized for COVID-19. We also evaluated correlations between the presence of these arrhythmias and mortality.MethodsWe reviewed the characteristics of all patients with COVID-19 admitted to our center over a 9-week period. Throughout hospitalization, we evaluated the incidence of cardiac arrests, arrhythmias, and inpatient mortality. We also used logistic regression to evaluate age, sex, race, body mass index, prevalent cardiovascular disease, diabetes, hypertension, chronic kidney disease, and intensive care unit (ICU) status as potential risk factors for each arrhythmia.ResultsAmong 700 patients (mean age 50 ± 18 years; 45% men; 71% African American; 11% received ICU care), there were 9 cardiac arrests, 25 incident AF events, 9 clinically significant bradyarrhythmias, and 10 NSVTs. All cardiac arrests occurred in patients admitted to the ICU. In addition, admission to the ICU was associated with incident AF (odds ratio [OR] 4.68; 95% confidence interval [CI] 1.66-13.18) and NSVT (OR 8.92; 95% CI 1.73-46.06) after multivariable adjustment. Also, age and incident AF (OR 1.05; 95% CI 1.02-1.09) and prevalent heart failure and bradyarrhythmias (OR 9.75; 95% CI 1.95-48.65) were independently associated. Only cardiac arrests were associated with acute in-hospital mortality.ConclusionCardiac arrests and arrhythmias are likely the consequence of systemic illness and not solely the direct effects of COVID-19 infection.Copyright © 2020. Published by Elsevier Inc.

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