Patients with COVID-19 who were admitted to an intensive care unit were 10 times more likely than other hospitalized COVID-19 patients to suffer cardiac arrest or heart rhythm disorders, according to a study published online June 22, 2020, in the Heart Rhythm Journal.
The researchers from the Perelman School of Medicine at the University of Pennsylvania say their findings, based on evaluation of 700 patients with COVID-19, provide greater clarity about the role played by the virus in the development of arrhythmias including atrial fibrillation, bradyarrhythmia, and non-sustained ventricular tachycardia (NSVT).
"In order to best protect and treat patients who develop COVID-19, it’s critical for us to improve our understanding of how the disease affects various organs and pathways within our body—including our heart rhythm abnormalities," said Rajat Deo, MD, MTR, senior study author and a cardiac electrophysiologist and an associate professor of Cardiovascular Medicine at Penn, in a Penn Medicine News release.
“Our findings suggest that non-cardiac causes such as systemic infection, inflammation and illness are likely to contribute more to the occurrence of cardiac arrest and arrhythmias than damaged or infected heart cells due to the viral infection,”
The research team evaluated 700 patients with COVID-19 who were admitted to the Hospital of the University of Pennsylvania between early March and mid-May; mean age was 50 years; 45% were men, 71% Black. Logistic regression was used to evaluate age, sex, race, BMI, prevalent cardiovascular disease, diabetes, hypertension, kidney disease and ICU status as potential risk factors for each arrhythmia.
After multivariable adjustment, ICU admission was associated with incident atrial fibrillation (OR 4.68 [95% CI 1.66 – 13.18]) and nonsustained SVT (OR 8.92 [95% CI 1.73 – 46.06]).
An independent association also was observed between 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]).
There were 53 cases of arrhythmias: 9 patients suffered cardiac arrest (all were admitted to ICU); 25 patients developed atrial fibrillation that required treatment; 9 patients had clinically significant bradyarrhythmias and 10 experienced NSVT events. There were no cases of heart block, sustained ventricular tachycardia, or ventricular fibrillation.
Of the 700 patients hospitalized, 11% received ICU care. Cardiac arrest did not occur among any of the other hospitalized patients. After controlling for underlying demographic and clinical factors, researchers found cardiac arrest and arrhythmias were more likely to occur among patients in an ICU compared to the other hospitalized patients.
“More research is needed to assess whether the presence of cardiac arrhythmias have long-term health effects on patients who were hospitalized for COVID-19,”said Deo in the news release. “In the meantime, it’s important that we launch studies to evaluate the most effective and safest strategies for long-term anticoagulation and rhythm management in this population.”
Authors noted that the study has several limitations, including that the analysis was conducted from a single center serving a large urban population.