TY - JOUR
T1 - Atrial Fibrillation in Patients Hospitalized With COVID-19
T2 - Incidence, Predictors, Outcomes, and Comparison to Influenza
AU - Musikantow, Daniel R.
AU - Turagam, Mohit K.
AU - Sartori, Samantha
AU - Chu, Edward
AU - Kawamura, Iwanari
AU - Shivamurthy, Poojita
AU - Bokhari, Mahmoud
AU - Oates, Connor
AU - Zhang, Chi
AU - Pumill, Christopher
AU - Malick, Waqas
AU - Hashemi, Helen
AU - Ruiz-Maya, Tania
AU - Hadley, Michael B.
AU - Gandhi, Jonathan
AU - Sperling, Dylan
AU - Whang, William
AU - Koruth, Jacob S.
AU - Langan, Marie Noelle
AU - Sofi, Aamir
AU - Gomes, Anthony
AU - Harcum, Stephanie
AU - Cammack, Sam
AU - Ellsworth, Betsy
AU - Dukkipati, Srinivas R.
AU - Bassily-Marcus, Adel
AU - Kohli-Seth, Roopa
AU - Goldman, Martin E.
AU - Halperin, Jonathan L.
AU - Fuster, Valentin
AU - Reddy, Vivek Y.
N1 - Funding Information:
Dr. Koruth has received consulting fees from Abbott Laboratories, CardioFocus, Farapulse, and Vytron US, Inc. Dr. Dukkipati has received grant support from Biosense Webster; and has equity with Farapulse and Manual Surgical Sciences, LLC. Dr. Halperin has received consulting fees from Boehringer Ingelheim, Johnson & Johnson-Janssen Pharmaceuticals, and Medtronic. Dr. Reddy is a consultant with Abbott, Ablacon, Acutus Medical, Affera, Apama Medical, Aquaheart, Atacor, Autonomix, Axon, Backbeat, BioSig, Biosense Webster, Biotronik, Boston Scientific, Cardiofocus, Cardionomic, CardioNXT / AFTx, Circa Scientific, Corvia Medical, Dinova-Hangzhou Nuomao Medtech Co., Ltd., East End Medical, EBR, EPD, Epix Therapeutics, EpiEP, Eximo, Fire1, Impulse Dynamics, Javelin, Kardium, Keystone Heart, LuxCath, Manual Surgical Sciences, Medlumics, Medtronic, Middlepeak, Newpace, Nuvera, Philips, Pulse Biosciences, Sirona Medical, Stimda, Surecor, Thermedical, and Valcare; and has equity in Ablacon, Acutus Medical, Affera, Apama, Aquaheart, Atacor, Autonomix, Backbeat, BioSig, Circa Scientific, Corvia Medical, Dinova-Hangzhou Nuomao Medtech Co., Ltd., East End Medical, EPD, Epix Therapeutics, EpiEP, Eximo, Fire 1, Javelin, Kardium, Keystone Heart, LuxCath, Manual Surgical Sciences, Medlumics, Middlepeak, Newpace, Nuvera, Sirona Medical, Surecor, Valcare, and Vizaramed.
Publisher Copyright:
© 2021 American College of Cardiology Foundation
PY - 2021/9
Y1 - 2021/9
N2 - Objectives: The 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). Background: COVID-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. Methods: This 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. Results: Among 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). Conclusions: AF/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.
AB - Objectives: The 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). Background: COVID-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. Methods: This 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. Results: Among 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). Conclusions: AF/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.
KW - atrial fibrillation
KW - atrial flutter
KW - coronavirus disease-2019
KW - influenza
KW - ischemic stroke
UR - http://www.scopus.com/inward/record.url?scp=85106218201&partnerID=8YFLogxK
U2 - 10.1016/j.jacep.2021.02.009
DO - 10.1016/j.jacep.2021.02.009
M3 - Article
C2 - 33895107
AN - SCOPUS:85106218201
SN - 2405-500X
VL - 7
SP - 1120
EP - 1130
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 9
ER -