TY - JOUR
T1 - Malignant Arrhythmias in Patients With COVID-19
T2 - Incidence, Mechanisms, and Outcomes
AU - Turagam, Mohit K.
AU - Musikantow, Daniel
AU - Goldman, Martin E.
AU - Bassily-Marcus, Adel
AU - Chu, Edward
AU - Shivamurthy, Poojita
AU - Lampert, Joshua
AU - Kawamura, Iwanari
AU - Bokhari, Mahmoud
AU - Whang, William
AU - Bier, Benjamin Aaron
AU - Malick, Waqas
AU - Hashemi, Helen
AU - Miller, Marc A.
AU - Choudry, Subbarao
AU - Pumill, Christopher
AU - Ruiz-Maya, Tania
AU - Hadley, Michael
AU - Giustino, Gennaro
AU - Koruth, Jacob S.
AU - Langan, Noelle
AU - Sofi, Aamir
AU - Dukkipati, Srinivas R.
AU - Halperin, Jonathan L.
AU - Fuster, Valentin
AU - Kohli-Seth, Roopa
AU - Reddy, Vivek Y.
N1 - Publisher Copyright:
© 2020 American Heart Association, Inc.
PY - 2020/11/1
Y1 - 2020/11/1
N2 - Background: Patients with coronavirus disease 2019 (COVID-19) who develop cardiac injury are reported to experience higher rates of malignant cardiac arrhythmias. However, little is known about these arrhythmias - their frequency, the underlying mechanisms, and their impact on mortality. Methods: We extracted data from a registry (NCT04358029) regarding consecutive inpatients with confirmed COVID-19 who were receiving continuous telemetric ECG monitoring and had a definitive disposition of hospital discharge or death. Between patients who died versus discharged, we compared a primary composite end point of cardiac arrest from ventricular tachycardia/fibrillation or bradyarrhythmias such as atrioventricular block. Results: Among 800 patients with COVID-19 at Mount Sinai Hospital with definitive dispositions, 140 patients had telemetric monitoring, and either died (52) or were discharged (88). The median (interquartile range) age was 61 years (48-74); 73% men; and ethnicity was White in 34%. Comorbidities included hypertension in 61%, coronary artery disease in 25%, ventricular arrhythmia history in 1.4%, and no significant comorbidities in 16%. Compared with discharged patients, those who died had elevated peak troponin I levels (0.27 versus 0.02 ng/mL) and more primary end point events (17% versus 4%, P=0.01) - a difference driven by tachyarrhythmias. Fatal tachyarrhythmias invariably occurred in the presence of severe metabolic imbalance, while atrioventricular block was largely an independent primary event. Conclusions: Hospitalized patients with COVID-19 who die experience malignant cardiac arrhythmias more often than those surviving to discharge. However, these events represent a minority of cardiovascular deaths, and ventricular tachyarrhythmias are mainly associated with severe metabolic derangement.
AB - Background: Patients with coronavirus disease 2019 (COVID-19) who develop cardiac injury are reported to experience higher rates of malignant cardiac arrhythmias. However, little is known about these arrhythmias - their frequency, the underlying mechanisms, and their impact on mortality. Methods: We extracted data from a registry (NCT04358029) regarding consecutive inpatients with confirmed COVID-19 who were receiving continuous telemetric ECG monitoring and had a definitive disposition of hospital discharge or death. Between patients who died versus discharged, we compared a primary composite end point of cardiac arrest from ventricular tachycardia/fibrillation or bradyarrhythmias such as atrioventricular block. Results: Among 800 patients with COVID-19 at Mount Sinai Hospital with definitive dispositions, 140 patients had telemetric monitoring, and either died (52) or were discharged (88). The median (interquartile range) age was 61 years (48-74); 73% men; and ethnicity was White in 34%. Comorbidities included hypertension in 61%, coronary artery disease in 25%, ventricular arrhythmia history in 1.4%, and no significant comorbidities in 16%. Compared with discharged patients, those who died had elevated peak troponin I levels (0.27 versus 0.02 ng/mL) and more primary end point events (17% versus 4%, P=0.01) - a difference driven by tachyarrhythmias. Fatal tachyarrhythmias invariably occurred in the presence of severe metabolic imbalance, while atrioventricular block was largely an independent primary event. Conclusions: Hospitalized patients with COVID-19 who die experience malignant cardiac arrhythmias more often than those surviving to discharge. However, these events represent a minority of cardiovascular deaths, and ventricular tachyarrhythmias are mainly associated with severe metabolic derangement.
KW - arrhythmias, cardiac
KW - atrioventricular block
KW - coronavirus
KW - myocardial infarction
KW - ventricular fibrillation
UR - http://www.scopus.com/inward/record.url?scp=85096351650&partnerID=8YFLogxK
U2 - 10.1161/CIRCEP.120.008920
DO - 10.1161/CIRCEP.120.008920
M3 - Article
C2 - 33026892
AN - SCOPUS:85096351650
SN - 1941-3149
VL - 13
SP - E008920
JO - Circulation: Arrhythmia and Electrophysiology
JF - Circulation: Arrhythmia and Electrophysiology
IS - 11
ER -