Cardiac Arrests, Arrhythmias in COVID-19 Also a Consequence of Systemic Illness

Cardiac arrests and arrhythmias observed in patients with coronavirus disease 2019 (COVID-19) were found to result from infection by the virus as well as systemic conditions, according to a study published in Heart Rhythm.

The data of 700 patients (mean age, 50±18 years; 71% Black; 45% men; 11% treated in intensive care unit [ICU]) hospitalized for COVID-19 over a 9-week period at a large urban hospital in Pennsylvania were examined. Clinical records were used to assess retrospectively the incidence of cardiac arrests, arrhythmias, and in-patient mortality during hospitalization. The role of several risk factors for arrhythmias were also examined in logistic regression analyses.

In this cohort, 9 cardiac arrests, 25 incident atrial fibrillation events, 9 clinically significant bradyarrhythmias, and 10 nonsustained ventricular tachycardia (NSVT) occurred. All cardiac arrests were reported in patients who received care in the ICU.

Admission to the ICU was found to be associated with incident NSVT (odds ratio [OR], 8.92; 95% CI, 1.73–46.06) and atrial fibrillation (OR, 4.68; 95% CI, 1.66–13.18) in a multivariable-adjusted logistic regression analysis. An independent association was found between age and incident atrial fibrillation (OR, 1.05; 95% CI, 1.02–1.09) and between prevalent heart failure and bradyarrhythmias (OR, 9.75; 95% CI, 1.95–48.65). In addition, cardiac arrests were found to be associated with acute in-hospital mortality in an exploratory analysis adjusted for age, sex, race, prevalence cardiovascular disease, ICU status, and hydroxychloroquine use (OR 34.99; 95% CI, 3.49–350.69).

Limitations of this study include its single-center approach, the inclusion of patients who were largely from an urban population, and the sole analysis of in-patient data for follow up.

”Cardiac arrest and arrhythmias were more likely to occur in the ICU population compared [with] the non-ICU population even after controlling for underlying demographic and clinical factors,” noted the study authors. “As such, cardiac arrests and arrhythmias are likely the consequence of systemic illness and not solely the direct effect of COVID-19 infection.”

Reference

Bhatla A, Mayer MM, Adusumalli S, et al. COVID-19 and cardiac arrhythmias [published online June 20, 2020]. Heart Rhythm. doi: 10.1016/j.hrthm.2020.06.016