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

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

doi:10.1016/j.jacep.2021.02.009

Abstract

ObjectivesThe 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).BackgroundCOVID-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.MethodsThis 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.ResultsAmong 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).ConclusionsAF/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.

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