JACC Clin Electrophysiol . Atrial Fibrillation in Patients Hospitalized With COVID-19: Incidence, Predictors, Outcomes and Comparison to Influenza

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JACC Clin Electrophysiol


. 2021 Feb 24;S2405-500X(21)00135-3.
doi: 10.1016/j.jacep.2021.02.009. Online ahead of print.
Atrial Fibrillation in Patients Hospitalized With COVID-19: Incidence, Predictors, Outcomes and Comparison to Influenza


Daniel R Musikantow ¹ , Mohit K Turagam ¹ , Samantha Sartori ¹ , Edward Chu ¹ , Iwanari Kawamura ¹ , Poojita Shivamurthy ¹ , Mahmoud Bokhari ¹ , Connor Oates ¹ , Chi Zhang ¹ , Christopher Pumill ¹ , Waqas Malick ¹ , Helen Hashemi ¹ , Tania Ruiz-Maya ¹ , Michael B Hadley ¹ , Jonathan Gandhi ¹ , Dylan Sperling ¹ , William Whang ² , Jacob S Koruth ² , Marie-Noelle Langan ² , Aamir Sofi ² , Anthony Gomes ² , Stephanie Harcum ² , Sam Cammack ² , Betsy Ellsworth ² , Srinivas R Dukkipati ² , Adel Bassily-Marcus ³ , Roopa Kohli-Seth ³ , Martin E Goldman ¹ , Jonathan L Halperin ¹ , Valentin Fuster ¹ , Vivek Y Reddy ⁴



Affiliations

• PMID: 33895107
• DOI: 10.1016/j.jacep.2021.02.009

Abstract

Objectives: The goal of this study is to determine the incidence, predictors, and outcomes of atrial fibrillation (AF) or atrial flutter (AFL) in patients hospitalized with coronavirus disease 2019 (COVID-19).
Background: COVID-19 results in increased inflammatory markers previously associated with atrial arrhythmias. However, little is known about their incidence or specificity in COVID-19 or their association with outcomes.
Methods: This is a retrospective analysis of 3,970 patients admitted with polymerase chain reaction-positive COVID-19 between February 4 and April 22, 2020, with manual review performed of 1,110. The comparator arm included 1,420 patients with influenza hospitalized between January 1, 2017, and January 1, 2020.
Results: Among 3,970 inpatients with COVID-19, the incidence of AF/AFL was 10% (n = 375) and in patients without a history of atrial arrhythmias it was 4% (n = 146). Patients with new-onset AF/AFL were older with increased inflammatory markers including interleukin 6 (93 vs. 68 pg/ml, p < 0.01), and more myocardial injury (troponin-I: 0.2 vs. 0.06 ng/ml, p < 0.01). AF and AFL were associated with increased mortality (46% vs. 26%, p < 0.01). Manual review captured a somewhat higher incidence of AF/AFL (13%, n = 140). Compared to inpatients with COVID-19, patients with influenza (n = 1,420) had similar rates of AF/AFL (12%, n = 163) but lower mortality. The presence of AF/AFL correlated with similarly increased mortality in both COVID-19 (relative risk: 1.77) and influenza (relative risk: 1.78).
Conclusions: AF/AFL occurs in a subset of patients hospitalized with either COVID-19 or influenza and is associated with inflammation and disease severity in both infections. The incidence and associated increase in mortality in both cohorts suggests that AF/AFL is not specific to COVID-19, but is rather a generalized response to the systemic inflammation of severe viral illnesses.

Keywords: atrial fibrillation; atrial flutter; coronavirus disease 2019; influenza; ischemic stroke.