Abstract
Background: COVID-19 infection started in China and became a pandemic, the SARS-CoV-2 virus mainly affects the respiratory system but can insult the cardiovascular system as well, higher rate of cardiac arrhythmias noted during the pandemic, and many studies showed that COVID-19 (especially hospitalized patients) can develop different types of arrhythmias which cause higher mortality rate. Objective: To assess the incidence of dysrhythmias and their types and outcomes in hospitalized patients with COVID-19 in Erbil city. Patients and Methods: Patients with documented COVID-19 infection admitted in Erbil Teaching Hospital respiratory care unit and coronary care unit from 1-8-2020 to 30-10-2020 had been included (255 patients) in this cross-sectional study, demographic data, and outcomes were reported, the ECG analyzed by cardiologists and the type of arrhythmia documented. Results: Mean age was 47±12 years, 61% of the patients were male, 25% of them had previous cardiac diseases, 20% diabetes, 16% multiple comorbidities, 8% hypertension, 8% obesity and 23% had no comorbidities, 20.7% of in-hospital patients developed dysrhythmias, 5.9% of them developed sinus tachycardia, 4.7% atrial fibrillation, 3.9% ventricular premature contractions, 2% ventricular fibrillation, 1.9% ventricular tachycardia and 1.9% heart blocks. Most of the patients who developed ventricular arrhythmias, atrial fibrillation, and heart block had previous comorbidities 82%, 62%, and 80% respectively. Arrhythmias caused a higher in-hospital mortality rate (39.6% versus 21.7%) especially among male patients (mortality rate in male patients 43% compared with female patients 33%). Conclusion: Most of the admitted cases were male. Most of them had comorbidities especially previous cardiac diseases. Sinus tachycardia, atrial fibrillation, and ventricular extra-systoles were the most frequent arrhythmias. The mortality rate was increased by arrhythmias mainly in male patients. Keywords: COVID-19, Dysrhythmias, Outcomes, Pandemic
Highlights
The underlying pathophysiology is elusive, various single-center studies and surveys around the world have reported a spectrum of dysrhythmias associated with the disease and its therapy, mainly atrioventricular heart block, atrial fibrillation, and polymorphic ventricular tachycardia
Among patients with ventricular tachycardia or ventricular fibrillation, 9 out of patients (82%) of them had a previous history of ischemic heart disease or heart failure, those patients with atrial fibrillation, 8 out of (67%) of them had either hypertension, diabetes or combined comorbidities (p-value= 0.08), those with bradarrhythmias 4 out of 5 (80%) patients had previous heart failure (p-value= 0.04), while only 5 out of 10 patients (50%) with ventricular extra-systoles had comorbidities, and 5 out of 15 patients (33%) of patients with sinus tachycardia had previous comorbidities( p-value= 0.06) as shown in Figure (3)
2021 Diyala Journal of Medicine hypertension, history of myocardial infarction and diabetes [27] this study showed that cardiovascular diseases including ischemic heart disease and heart failure were the main comorbidity in COVID-19 patients who developed ventricular fibrillation, sustained ventricular tachycardia, heart block, and atrial fibrillation
Summary
Coronaviruses are important pathogens in both animals and humans, the novel coronavirus COVID -19, started in Wuhan city in Hubei Province in China rapidly became a pandemic and led to a considerable number of mortality [1]. respiratory system involvement is the most common manifestation of SARSCoV-2 infection, there are well documented cardiac insults in form of myocarditis, heart failure, acute coronary syndrome, and pericarditis [2].Dysrhythmias generally can occur with many viral infections; the possible mechanisms for arrhythmogenicity are altered intercellular coupling, interstitial edema, and cardiac fibrosis which can lead to abnormal conduction in addition to abnormal Ca2+ handling and down-regulation of K+ channels those results in repolarization abnormalities and action potential conduction abnormalities [3, 4].Direct viral insult to the myocardium causing inflammation,, and through interaction with angiotensin-converting enzyme 2 resulting in its down-regulation and loss of its cardio-protective effect in addition to electrolyte abnormalities and QT prolongation are among factors resulting in arrhythmias in COVID-19 patients [4]. the underlying pathophysiology is elusive, various single-center studies and surveys around the world have reported a spectrum of dysrhythmias associated with the disease and its therapy, mainly atrioventricular heart block, atrial fibrillation, and polymorphic ventricular tachycardia [5].Coexisting hypoxia, electrolyte abnormalities, and the administration of arrhythmogenic drugs (hydroxychloroquine and azithromycin) lead to great difficulty in ascertaining the direct and indirect roles of SARS-CoV-2 in the reported arrhythmias [4]. The underlying pathophysiology is elusive, various single-center studies and surveys around the world have reported a spectrum of dysrhythmias associated with the disease and its therapy, mainly atrioventricular heart block, atrial fibrillation, and polymorphic ventricular tachycardia [5]. COVID-19 infection started in China and became a pandemic, the SARSCoV-2 virus mainly affects the respiratory system but can insult the cardiovascular system as well, higher rate of cardiac arrhythmias noted during the pandemic, and many studies showed that COVID-19 (especially hospitalized patients) can develop different types of arrhythmias which cause higher mortality rate. Patients and Methods: Patients with documented COVID-19 infection admitted in Erbil Teaching Hospital respiratory care unit and coronary care unit from 1-8-2020 to 30-10-2020 had been included (255 patients) in this cross-sectional study, demographic data, and outcomes were reported, the ECG analyzed by cardiologists and the type of arrhythmia documented.
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