Year-end Sale % OFF 
Abstract
Aims: Thromboembolic events, including stroke, are typical complications of COVID-19. Whether arrhythmias, frequently described in severe COVID-19, are disease-specific and thus promote strokes is unclear. We investigated the occurrence of arrhythmias and stroke during rhythm monitoring in critically ill patients with COVID-19, compared with severe pneumonia of other origins.Methods and Results: This retrospective study included 120 critically ill patients requiring mechanical ventilation in three European tertiary hospitals, including n =60 COVID-19, matched according to risk factors for the occurrence of arrhythmias in n = 60 patients from a retrospective consecutive cohort of severe pneumonia of other origins. Arrhythmias, mainly atrial fibrillation (AF), were frequent in COVID-19. However, when compared with non-COVID-19, no difference was observed with respect to ventricular tachycardias (VT) and relevant bradyarrhythmias (VT 10.0 vs. 8.4 %, p = ns and asystole 5.0 vs. 3.3%, p = ns) with consequent similar rates of cardiopulmonary resuscitation (6.7 vs. 10.0%, p = ns). AF was even more common in non-COVID-19 (AF 18.3 vs. 43.3%, p = 0.003; newly onset AF 10.0 vs. 30.0%, p = 0.006), which resulted in a higher need for electrical cardioversion (6.7 vs. 20.0%, p = 0.029). Despite these findings and comparable rates of therapeutic anticoagulation (TAC), the incidence of stroke was higher in COVID-19 (6.7.% vs. 0.0, p = 0.042). These events also happened in the absence of AF (50%) and with TAC (50%).Conclusions: Arrhythmias were common in severe COVID-19, consisting mainly of AF, yet less frequent than in matched pneumonia of other origins. A contrasting higher incidence of stroke independent of arrhythmias also observed with TAC, seems to be an arrhythmia-unrelated disease-specific feature of COVID-19.
Highlights
The novel coronavirus disease COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a worldwide healthcare crisis with an overstrain of hospital resources [1, 2]
Severe pneumonia was defined as pneumonia-associated respiratory failure requiring mechanical ventilation [noninvasive ventilation (NIV) or invasive ventilation]; the term NIV in this study refers to mechanical ventilation involving end-expiratory and inspiratory positive air pressure support via a tightly fitted face mask or helmet, as opposed to invasive ventilation necessitating endotracheal intubation
The same rates of heart failure, coronary artery disease, and paroxysmal atrial fibrillation (AF) were present in both groups at inclusion
Summary
The novel coronavirus disease COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a worldwide healthcare crisis with an overstrain of hospital resources [1, 2]. A recent work of Bertini et al analyzed ECGs in critically ill COVID-19 patients and reported a high rate of ECG abnormalities (93%) with atrial fibrillation/flutter being the most common arrhythmia (22%) [9]. The majority of patients in those studies received at least a prophylactic anticoagulation [13,14,15] These findings suggest a potential correlation between cardiac arrhythmias and high rates of stroke and other thromboembolic events. In our multicentre study, we aimed for a comparative analysis of cardiac arrhythmias as well as stroke and other thromboembolic events in critically ill patients requiring ventilator therapy due to SARS-CoV-2 induced pneumonia matched to a historical cohort requiring respiratory support due to severe pneumonia of non-COVID-19 origin (nonCOVID-19)
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
