Emergence of Atrial Fibrillation and Flutter in COVID-19 Patients: A Retrospective Cohort Study
Abstract
:1. Introduction
2. Methods
3. Results
4. Discussion
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Shi, Y.; Wang, G.; Cai, X.-P.; Deng, J.-W.; Zheng, L.; Zhu, H.-H.; Zheng, M.; Yang, B.; Chen, Z. An overview of COVID-19. J. Zhejiang Univ. Sci. B 2020, 21, 343–360. [Google Scholar] [CrossRef] [PubMed]
- Jee, Y. WHO International Health Regulations Emergency Committee for the COVID-19 outbreak. Epidemiol. Health 2020, 42, e2020013. [Google Scholar] [CrossRef]
- Zhou, F.; Yu, T.; Du, R.; Fan, G.; Liu, Y.; Liu, Z.; Xiang, J.; Wang, Y.; Song, B.; Gu, X.; et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet 2020, 395, 1054–1062. [Google Scholar] [CrossRef] [PubMed]
- Keri, V.C.; Hooda, A.; Kodan, P.; RL, B.; Jorwal, P.; Wig, N. Intricate interplay between Covid-19 and cardiovascular diseases. Rev. Med. Virol. 2021, 31, e2188. [Google Scholar] [CrossRef]
- Mitrani, R.D.; Dabas, N.; Goldberger, J.J. COVID-19 cardiac injury: Implications for long-term surveillance and outcomes in survivors. Heart Rhythm. 2020, 17, 1984–1990. [Google Scholar] [CrossRef]
- Zaman, S.; MacIsaac, A.I.; Jennings, G.L.; Schlaich, M.P.; Inglis, S.C.; Arnold, R.; Kumar, S.; Thomas, L.; Wahi, S.; Lo, S. Cardiovascular disease and COVID-19: Australian and New Zealand consensus statement. Med. J. Aust. 2020, 213, 182–187. [Google Scholar] [CrossRef]
- Zylla, M.M.; Merle, U.; Vey, J.A.; Korosoglou, G.; Hofmann, E.; Müller, M.; Herth, F.; Schmidt, W.; Blessing, E.; Göggelmann, C.; et al. Predictors and Prognostic Implications of Cardiac Arrhythmias in Patients Hospitalized for COVID-19. J. Clin. Med. 2021, 10, 133. [Google Scholar] [CrossRef] [PubMed]
- Denegri, A.; Sola, M.; Morelli, M.; Farioli, F.; Alberto, T.; D’Arienzo, M.; Savorani, F.; Pezzuto, G.S.; Boriani, G.; Szarpak, L.; et al. Arrhythmias in COVID-19/SARS-CoV-2 Pneumonia Infection: Prevalence and Implication for Outcomes. J. Clin. Med. 2022, 11, 1463. [Google Scholar] [CrossRef]
- Berman, J.P.; Abrams, M.P.; Kushnir, A.; Rubin, G.A.; Ehlert, F.; Biviano, A.; Morrow, J.P.; Dizon, J.; Wan, E.Y.; Yarmohammadi, H.; et al. Cardiac electrophysiology consultative experience at the epicenter of the COVID-19 pandemic in the United States. Indian Pacing Electrophysiol. J. 2020, 20, 250–256. [Google Scholar] [CrossRef]
- Wang, D.; Hu, B.; Hu, C.; Zhu, F.; Liu, X.; Zhang, J.; Wang, B.; Xiang, H.; Cheng, Z.; Xiong, Y.; et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA 2020, 323, 1061–1069. [Google Scholar] [CrossRef]
- Gottlieb, M.; Sansom, S.; Frankenberger, C.; Ward, E.; Hota, B. Clinical Course and Factors Associated with Hospitalization and Critical Illness Among COVID-19 Patients in Chicago, Illinois. Acad. Emerg. Med. 2020, 27, 963–973. [Google Scholar] [CrossRef]
- Bertini, M.; Ferrari, R.; Guardigli, G.; Malagù, M.; Vitali, F.; Zucchetti, O.; D’Aniello, E.; Volta, C.A.; Cimaglia, P.; Piovaccari, G.; et al. Electrocardiographic features of 431 consecutive, critically ill COVID-19 patients: An insight into the mechanisms of cardiac involvement. EP Eur. 2020, 22, 1848–1854. [Google Scholar] [CrossRef]
- Joglar, J.A.; Chung, M.K.; Armbruster, A.L.; Benjamin, E.J.; Chyou, J.Y.; Cronin, E.M.; Deswal, A.; Eckhardt, L.L.; Goldberger, Z.D.; Gopinathannair, R.; et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2024, 149, e1–e156. [Google Scholar] [CrossRef]
- Alonso, A.; Krijthe, B.P.; Aspelund, T.; Stepas, K.A.; Pencina, M.J.; Moser, C.B.; Sinner, M.F.; Sotoodehnia, N.; Fontes, J.D.; Janssens, A.C.J.W.; et al. Simple Risk Model Predicts Incidence of Atrial Fibrillation in a Racially and Geographically Diverse Population: The CHARGE-AF Consortium. J. Am. Heart Assoc. 2013, 2, e000102. [Google Scholar] [CrossRef] [PubMed]
- Allan, V.; Honarbakhsh, S.; Casas, J.P.; Wallace, J.; Hunter, R.; Schilling, R.; Perel, P.; Morley, K.; Banerjee, A.; Hemingway, H. Are cardiovascular risk factors also associated with the incidence of atrial fibrillation? A systematic review and field synopsis of 23 factors in 32 population-based cohorts of 20 million participants. Thromb. Haemost. 2017, 117, 837–850. [Google Scholar] [CrossRef]
- Walkey, A.J.; Wiener, R.S.; Ghobrial, J.M.; Curtis, L.H.; Benjamin, E.J. Incident Stroke and Mortality Associated With New-Onset Atrial Fibrillation in Patients Hospitalized With Severe Sepsis. JAMA 2011, 306, 2248–2254. [Google Scholar] [CrossRef] [PubMed]
- Peltzer, B.; Manocha, K.K.; Ying, X.; Kirzner, J.; Ip, J.E.; Thomas, G.; Liu, C.F.; Markowitz, S.M.; Lerman, B.B.; Safford, M.M.; et al. Arrhythmic Complications of Patients Hospitalized With COVID-19. Circ. Arrhythmia Electrophysiol. 2020, 13, 1229–1232. [Google Scholar] [CrossRef] [PubMed]
- Odutayo, A.; Wong, C.X.; Hsiao, A.J.; Hopewell, S.; Altman, D.G.; Emdin, C.A. Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: Systematic review and meta-analysis. BMJ 2016, 354, i4482. [Google Scholar] [CrossRef]
- Papanastasiou, C.A.; Theochari, C.A.; Zareifopoulos, N.; Arfaras-Melainis, A.; Giannakoulas, G.; Karamitsos, T.D.; Palaiodimos, L.; Ntaios, G.; Avgerinos, K.I.; Kapogiannis, D.; et al. Atrial Fibrillation Is Associated with Cognitive Impairment, All-Cause Dementia, Vascular Dementia, and Alzheimer’s Disease: A Systematic Review and Meta-Analysis. J. Gen. Intern. Med. 2021, 36, 3122–3135. [Google Scholar] [CrossRef]
- Ruddox, V.; Sandven, I.; Munkhaugen, J.; Skattebu, J.; Edvardsen, T.; Otterstad, J.E. Atrial fibrillation and the risk for myocardial infarction, all-cause mortality and heart failure: A systematic review and meta-analysis. Eur. J. Prev. Cardiol. 2017, 24, 1555–1566. [Google Scholar] [CrossRef]
- Rattanawong, P.; Upala, S.; Riangwiwat, T.; Jaruvongvanich, V.; Sanguankeo, A.; Vutthikraivit, W.; Chung, E.H. Atrial fibrillation is associated with sudden cardiac death: A systematic review and meta-analysis. J. Interv. Card. Electrophysiol. 2018, 51, 91–104. [Google Scholar] [CrossRef]
- Walkey, A.J.; Greiner, M.A.; Heckbert, S.R.; Jensen, P.N.; Piccini, J.P.; Sinner, M.F.; Curtis, L.H.; Benjamin, E.J. Atrial fibrillation among Medicare beneficiaries hospitalized with sepsis: Incidence and risk factors. Am. Heart. J. 2013, 165, 949–955.e3. [Google Scholar] [CrossRef] [PubMed]
- Sonaglioni, A.; Lombardo, M.; Albini, A.; Noonan, D.M.; Re, M.; Cassandro, R.; Elia, D.; Caminati, A.; Nicolosi, G.L.; Harari, S. Charlson comorbidity index, neutrophil-to-lymphocyte ratio and undertreatment with renin-angiotensin-aldosterone system inhibitors predict in-hospital mortality of hospitalized COVID-19 patients during the omicron dominant period. Front. Immunol. 2022, 13, 958418. [Google Scholar] [CrossRef]
- Kochi, A.N.; Tagliari, A.P.; Forleo, G.B.; Fassini, G.M.; Tondo, C. Cardiac and arrhythmic complications in patients with COVID-19. J. Cardiovasc. Electrophysiol. 2020, 31, 1003–1008. [Google Scholar] [CrossRef] [PubMed]
- Shi, S.; Qin, M.; Shen, B.; Cai, Y.; Liu, T.; Yang, F.; Gong, W.; Liu, X.; Liang, J.; Zhao, Q.; et al. Association of Cardiac Injury with Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol. 2020, 5, 802–810. [Google Scholar] [CrossRef]
- Alblaihed, L.; Brady, W.J.; Al-Salamah, T.; Mattu, A. Dysrhythmias associated with COVID-19: Review and management considerations. Am. J. Emerg. Med. 2023, 64, 161–168. [Google Scholar] [CrossRef]
- Xiong, T.Y.; Redwood, S.; Prendergast, B.; Chen, M. Coronaviruses and the cardiovascular system: Acute and long-term implications. Eur. Heart J. 2020, 41, 1798–1800. [Google Scholar] [CrossRef] [PubMed]
- Lazzerini, P.E.; Boutjdir, M.; Capecchi, P.L. COVID-19, Arrhythmic Risk, and Inflammation. Circulation 2020, 142, 7–9. [Google Scholar] [CrossRef]
- Guo, T.; Fan, Y.; Chen, M.; Wu, X.; Zhang, L.; He, T.; Wang, H.; Wan, J.; Wang, X.; Lu, Z. Cardiovascular Implications of Fatal Outcomes of Patients with Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020, 5, 811. [Google Scholar] [CrossRef]
- Dherange, P.; Lang, J.; Qian, P.; Oberfeld, B.; Sauer, W.H.; Koplan, B.; Tedrow, U. Arrhythmias and COVID-19. JACC Clin. Electrophysiol. 2020, 6, 1193–1204. [Google Scholar] [CrossRef]
- Kuipers, S.; Klein Klouwenberg, P.M.; Cremer, O.L. Incidence, risk factors and outcomes of new-onset atrial fibrillation in patients with sepsis: A systematic review. Crit. Care 2014, 18, 688. [Google Scholar] [CrossRef] [PubMed]
- Lin, Y.-K.; Chen, Y.-A.; Lee, T.-I.; Chen, Y.-C.; Chen, S.-A.; Chen, Y.-J. Aging Modulates the Substrate and Triggers Remodeling in Atrial Fibrillation. Circ. J. 2018, 82, 1237–1244. [Google Scholar] [CrossRef] [PubMed]
- Wen, W.; Zhang, H.; Zhou, M.; Cheng, Y.; Ye, L.; Chen, J.; Wang, M.; Feng, Z. Arrhythmia in patients with severe coronavirus disease (COVID-19): A meta-analysis. Eur. Rev. Med. Pharmacol. Sci. 2020, 24, 11395–11401. [Google Scholar] [PubMed]
- Zuin, M.; Ojeda-Fernández, L.; Torrigiani, G.; Bertini, M. Risk of Incident Atrial Fibrillation after COVID-19 Infection: A Systematic Review and Meta-Analysis. Heart Rhythm. 2024; online ahead of print. [Google Scholar] [CrossRef] [PubMed]
- Raman, B.; Bluemke, D.A.; Lüscher, T.F.; Neubauer, S. Long COVID: Post-acute sequelae of COVID-19 with a cardiovascular focus. Eur. Heart J. 2022, 43, 1157–1172. [Google Scholar] [CrossRef]
- Bhatla, A.; Mayer, M.M.; Adusumalli, S.; Hyman, M.C.; Oh, E.; Tierney, A.; Moss, J.; Chahal, A.A.; Anesi, G.; Denduluri, S.; et al. COVID-19 and cardiac arrhythmias. Heart Rhythm. 2020, 17, 1439–1444. [Google Scholar] [CrossRef]
- Rattanawong, P.; Shen, W.; El Masry, H.; Sorajja, D.; Srivathsan, K.; Valverde, A.; Scott, L.R. Guidance on Short-Term Management of Atrial Fibrillation in Coronavirus Disease 2019. J. Am. Heart Assoc. 2020, 9, e017529. [Google Scholar] [CrossRef]
- Lavelle, M.P.; Desai, A.D.; Wan, E.Y. Arrhythmias in the COVID-19 patient. Heart Rhythm. O2 2022, 3, 8–14. [Google Scholar] [CrossRef]
- Rubin, G.A.; Desai, A.D.; Chai, Z.; Wang, A.; Chen, Q.; Wang, A.S.; Kemal, C.; Baksh, H.; Biviano, A.; Dizon, J.M.; et al. Cardiac Corrected QT Interval Changes Among Patients Treated for COVID-19 Infection During the Early Phase of the Pandemic. JAMA Netw. Open 2021, 4, e216842. [Google Scholar] [CrossRef]
- Manolis, A.S.; Manolis, A.A.; Manolis, T.A.; Apostolopoulos, E.J.; Papatheou, D.; Melita, H. COVID-19 infection and cardiac arrhythmias. Trends Cardiovasc. Med. 2020, 30, 451–460. [Google Scholar] [CrossRef]
Variable | No. (%) or Mean |
---|---|
Age | Mean, Years |
Overall Population | 58.1 ± 18.8 |
Population With AFB/AFL | 72.3 ± 12.1 |
Population Without AFB/AFL | 57.1 ± 18.8 |
Sex | N (%) |
Male | 384 (59.4%) |
Female | 267 (40.6%) |
Race/Ethnicity | N (%) |
White | 243 (37.6%) |
Black/African American | 133 (20.6%) |
Hispanic/Latino | 42 (6.5%) |
Eastern Asian | 23 (3.6%) |
South Asian | 191 (29.5%) |
Native Hawaiian/Pacific Islander | 9 (1.4%) |
American Indian/Alaskan | 5 (0.8%) |
Variable | Odds Ratio | 95% CI Lower | 95% CI Upper | Significance (p Value) |
---|---|---|---|---|
Sepsis (0—no sepsis, 1—sepsis) | 2.723 | 1.31 | 5.70 | 0.01 * |
Age ≥ 65 (0 < 65, 1 ≥ 65) | 5.43 | 2.31 | 12.77 | <0.001 * |
Gender (0 = Male, 1 = Female) | 1.50 | 0.72 | 3.09 | 0.28 |
Diabetes Mellitus (0 = No DM, 1 = DM) | 1.00 | 0.46 | 2.20 | 0.99 |
BMI Categories (0—underweight = <18.5; 1—normal = 18.5–24.9; 2—overweight = 25–29.9; 3—obese class I—30–34.9; 4—obese class II—35–39.9; 5—morbid obesity—equal to or more > 40) | ||||
Normal (18.5–24.9) | 0.53 | 0.05 | 5.34 | 0.59 |
Overweight (25–29.9) | 0.65 | 0.07 | 6.28 | 0.71 |
Obese Class I (30–34.9) | 1.18 | 0.12 | 12.06 | 0.89 |
Obese Class II (35–39.9) | 0.55 | 0.04 | 7.57 | 0.65 |
Morbid Obesity (≥40) | 1.53 | .12 | 19.23 | 0.74 |
Hypertension (0—no hypertension, 1—hypertension) | 1.54 | 0.66 | 3.59 | 0.32 |
CAD (0 = no CAD, 1 = CAD) | 0.87 | 0.32 | 2.35 | 0.78 |
Race 0 = White 1 = Black/African American 2 = Hispanic/Latino 3 = Eastern Asian 4 = South Asian 5 = Native Hawaiian/Pacific Islander 6 = American Indian/Alaskan | ||||
Black/African American | 0.27 | 0.08 | 0.96 | 0.16 |
Hispanic/Latino | 1.67 | 0.52 | 5.26 | 0.12 |
Eastern Asian | 4.88 | 0.86 | 27.75 | 0.21 |
South Asian | 1.2 | 0.52 | 2.78 | 0.71 |
Native Hawaiian/Pacific Islander | † | † | † | † |
American Indian/Alaskan | † | † | † | † |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Bhuiya, T.; Shah, P.P.; Lau, W.H.; Park, T.; Munshi, R.F.; Hai, O.; Zeltser, R.; Makaryus, A.N. Emergence of Atrial Fibrillation and Flutter in COVID-19 Patients: A Retrospective Cohort Study. Healthcare 2024, 12, 1682. https://doi.org/10.3390/healthcare12171682
Bhuiya T, Shah PP, Lau WH, Park T, Munshi RF, Hai O, Zeltser R, Makaryus AN. Emergence of Atrial Fibrillation and Flutter in COVID-19 Patients: A Retrospective Cohort Study. Healthcare. 2024; 12(17):1682. https://doi.org/10.3390/healthcare12171682
Chicago/Turabian StyleBhuiya, Tanzim, Paras P. Shah, Wing Hang Lau, Timothy Park, Rezwan F. Munshi, Ofek Hai, Roman Zeltser, and Amgad N. Makaryus. 2024. "Emergence of Atrial Fibrillation and Flutter in COVID-19 Patients: A Retrospective Cohort Study" Healthcare 12, no. 17: 1682. https://doi.org/10.3390/healthcare12171682