tetano
Editor, Senior Moderator
Int J Clin Pract
. 2020 Oct 30;e13788.
doi: 10.1111/ijcp.13788. Online ahead of print.
Cardiac arrhythmias among hospitalized Coronavirus 2019 (COVID-19) patients: prevalence, characterization, and clinical algorithm to classify arrhythmic risk
Moshe Rav-Acha[SUP] 1 [/SUP], Amir Orlev[SUP] 1 [/SUP], Itay Itzhaki[SUP] 2 [/SUP], Shmuel F Zimmerman[SUP] 3 [/SUP], Bashar Fteiha[SUP] 4 [/SUP], Davina Bohm[SUP] 4 [/SUP], Ramzi Kurd[SUP] 4 [/SUP], Tal Y Samuel[SUP] 1 [/SUP], Elad Asher[SUP] 1 [/SUP], Igal Helviz[SUP] 3 [/SUP], Michael Glikson[SUP] 1 [/SUP], Yoav Michowitz[SUP] 1 [/SUP]
Affiliations
Abstract
Objectives: A significant proportion of COVID-19 patients may have cardiac involvement including arrhythmias. Although arrhythmia characterization and possible predictors were previously reported, there are conflicting data regarding the exact prevalence of arrhythmias. Clinically applicable algorithms to classify COVID patients' arrhythmic risk are still lacking, and are the aim of our study.
Methods: We describe a single center cohort of hospitalized patients with a positive nasopharyngeal swab for COVID-19 during the initial Israeli outbreak between 1/2/2020 -30/5/2020. The study's outcome was any documented arrhythmia during hospitalization, based on daily physical examination, routine ECG's, periodic 24-hour Holter, and continuous monitoring. Multivariate analysis was used to find predictors for new arrhythmias and create classification trees for discriminating patients with high and low arrhythmic risk.
Results: Out of 390 COVID-19 patients included, 28 (7.2%) had documented arrhythmias during hospitalization, including: 23 atrial tachyarrhythmias, combined atrial fibrillation (AF) and ventricular fibrillation, ventricular tachycardia storm, and 3 bradyarrhythmias. Only 7/28 patients had previous arrhythmias. Our study showed significant correlation between disease severity and arrhythmia prevalence (p<0.001) with a low arrhythmic prevalence among mild disease patients (2%). Multivariate analysis revealed background heart failure (CHF) and disease severity are independently associated with overall arrhythmia while age, CHF, disease severity, and arrhythmic symptoms are associated with tachyarrhythmias. A novel decision tree using age, disease severity, CHF, and troponin levels was created to stratify patients into high and low risk for developing arrhythmia.
Conclusions: Dominant arrhythmia among COVID-19 patients is AF. Arrhythmia prevalence is associated with age, disease severity, CHF, and troponin levels. A novel simple Classification tree, based on these parameters, can discriminate between high and low arrhythmic risk patients.
. 2020 Oct 30;e13788.
doi: 10.1111/ijcp.13788. Online ahead of print.
Cardiac arrhythmias among hospitalized Coronavirus 2019 (COVID-19) patients: prevalence, characterization, and clinical algorithm to classify arrhythmic risk
Moshe Rav-Acha[SUP] 1 [/SUP], Amir Orlev[SUP] 1 [/SUP], Itay Itzhaki[SUP] 2 [/SUP], Shmuel F Zimmerman[SUP] 3 [/SUP], Bashar Fteiha[SUP] 4 [/SUP], Davina Bohm[SUP] 4 [/SUP], Ramzi Kurd[SUP] 4 [/SUP], Tal Y Samuel[SUP] 1 [/SUP], Elad Asher[SUP] 1 [/SUP], Igal Helviz[SUP] 3 [/SUP], Michael Glikson[SUP] 1 [/SUP], Yoav Michowitz[SUP] 1 [/SUP]
Affiliations
- PMID: 33128270
- DOI: 10.1111/ijcp.13788
Abstract
Objectives: A significant proportion of COVID-19 patients may have cardiac involvement including arrhythmias. Although arrhythmia characterization and possible predictors were previously reported, there are conflicting data regarding the exact prevalence of arrhythmias. Clinically applicable algorithms to classify COVID patients' arrhythmic risk are still lacking, and are the aim of our study.
Methods: We describe a single center cohort of hospitalized patients with a positive nasopharyngeal swab for COVID-19 during the initial Israeli outbreak between 1/2/2020 -30/5/2020. The study's outcome was any documented arrhythmia during hospitalization, based on daily physical examination, routine ECG's, periodic 24-hour Holter, and continuous monitoring. Multivariate analysis was used to find predictors for new arrhythmias and create classification trees for discriminating patients with high and low arrhythmic risk.
Results: Out of 390 COVID-19 patients included, 28 (7.2%) had documented arrhythmias during hospitalization, including: 23 atrial tachyarrhythmias, combined atrial fibrillation (AF) and ventricular fibrillation, ventricular tachycardia storm, and 3 bradyarrhythmias. Only 7/28 patients had previous arrhythmias. Our study showed significant correlation between disease severity and arrhythmia prevalence (p<0.001) with a low arrhythmic prevalence among mild disease patients (2%). Multivariate analysis revealed background heart failure (CHF) and disease severity are independently associated with overall arrhythmia while age, CHF, disease severity, and arrhythmic symptoms are associated with tachyarrhythmias. A novel decision tree using age, disease severity, CHF, and troponin levels was created to stratify patients into high and low risk for developing arrhythmia.
Conclusions: Dominant arrhythmia among COVID-19 patients is AF. Arrhythmia prevalence is associated with age, disease severity, CHF, and troponin levels. A novel simple Classification tree, based on these parameters, can discriminate between high and low arrhythmic risk patients.