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 - 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 -