Abstract
Arrhythmias have been reported frequently in COVID-19 patients, but the incidence and nature have not been well characterized. Patients admitted with COVID-19 and monitored by telemetry were prospectively enrolled in the study. Baseline characteristics, hospital course, treatment and complications were collected from the patients' medical records. Telemetry was monitored to detect the incidence of cardiac arrhythmias. The incidence and types of cardiac arrhythmias were analyzed and compared between survivors and non-survivors. Among 143 patients admitted with telemetry monitoring, overall in-hospital mortality was 25.2% (36/143 patients) during the period of observation (mean follow-up 23.7 days). Survivors were less tachycardic on initial presentation (heart rate 90.6 ± 19.6 vs. 99.3 ± 23.1 bpm, p = 0.030) and had lower troponin (peak troponin 0.03 vs. 0.18 ng/ml. p = 0.004), C-reactive protein (peak C-reactive protein 97 vs. 181 mg/dl, p = 0.029), and interleukin-6 levels (peak interleukin-6 30 vs. 246 pg/ml, p = 0.003). Sinus tachycardia, the most common arrhythmia (detected in 39.9% [57/143] of patients), occurred more frequently in non-survivors (58.3% vs. 33.6% in survivors, p = 0.009). Premature ventricular complexes occurred in 28.7% (41/143), and non-sustained ventricular tachycardia in 15.4% (22/143) of patients, with no difference between survivors and non-survivors. Sustained ventricular tachycardia and ventricular fibrillation were not frequent (seen only in 1.4% and 0.7% of patients, respectively). Contrary to reports from other regions, overall mortality was higher and ventricular arrhythmias were infrequent in this hospitalized and monitored COVID-19 population. Either disease or management-related factors could explain this divergence of clinical outcomes, and should be urgently investigated.
Highlights
The 2019 novel coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) resulted in a worldwide, rapidly spreading and high mortality pandemic
P value 0.014 0.837 1.000 0.124 0.200 0.487 0.072 0.031 1.000. In this prospective observational study of hospitalized and monitored patients with COVID19, sinus tachycardia was the most common rhythm disorder and its presence was associated with higher in-hospital mortality
A recent study of 138 hospitalized COVID-19 patients in Wuhan, China revealed that cardiac arrhythmias were common complications occurring in 16.7% (23/138) of patients, but the details of ventricular arrhythmias (VA) were not described [4]
Summary
The 2019 novel coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) resulted in a worldwide, rapidly spreading and high mortality pandemic. A recent study of 138 hospitalized COVID-19 patients in Wuhan, China revealed that cardiac arrhythmias were common complications occurring in 16.7% (23/138) of patients but details about the arrhythmias were not reported [4]. Another study in China revealed that ventricular tachycardia (VT) or ventricular fibrillation (VF) occurred in 17.3% (9/52 patients) of hospitalized COVID-19 patients with elevated troponin [5]. VT or VF were frequent complications in patients with COVID-19 in China, the detailed incidence and characteristics of cardiac arrhythmias in other parts of the world are unknown. We conducted a prospective observational study to analyze the incidence and predictors of cardiac arrhythmias in patients admitted to the hospital with COVID-19 in an academic institution in the Western United States
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