Outcomes and Mortality Associated with Atrial Arrhythmias Among Patients Hospitalized with COVID-19

Introduction: The impact of atrial arrhythmias on COVID-19-associated outcomes are unclear. We sought to identify prevalence, risk factors and outcomes associated with atrial arrhythmias among patients hospitalized with COVID-19.

Methods: An observational cohort study of 1053 patients with SARS-CoV2 infection admitted to a quaternary care hospital and a community hospital was conducted. Data from electrocardiographic and telemetry were collected to identify atrial fibrillation (AF) or atrial flutter/tachycardia (AFL). The association between atrial arrhythmias and 30-day mortality was assessed with multivariable analysis.

Results: Mean age of patients was 62 ± 17 years and 62% were men. Atrial arrhythmias were identified in 166 (15.8%) patients, with AF in 154 (14.6%) patients and AFL in 40 (3.8%) patients. Newly detected atrial arrhythmias occurred in 101 (9.6%) patients. Age, male sex, prior AF, renal disease, and hypoxia on presentation were independently associated with AF/AFL occurrence. Compared to patients without AF/AFL, patients with AF/AFL had significantly higher levels of troponin, B-type natriuretic peptide, C-reactive protein, ferritin and D-dimer. Mortality was significantly higher among patients with AF/AFL (39.2%) compared to patients without (13.4%; P<0.001). After adjustment for age and co-morbidities, AF/AFL (adjusted OR 1.93; P = 0.007) and newly detected AF/AFL (adjusted OR 2.87; P <0.001) were independently associated with 30-day mortality.

Conclusions: Atrial arrhythmias are common among patients hospitalized with COVID-19. The presence of AF/AFL tracked with markers of inflammation and cardiac injury. Atrial arrhythmias were independently associated with increased mortality. This article is protected by copyright. All rights reserved.

Keywords: Atrial fibrillation; COVID-19; atrial flutter; mortality; outcomes.