Incidence of New-Onset Atrial Fibrillation and Flutter in COVID-19 Patients 1 Shah ,
2 MD ;
2 MD ;
Paras P. BA; Wing Hang Lau, Timothy Park, Rezwan Munshi, 2 1,2 1,2 Ofek Hai, DO ; Roman Zeltser, MD ; and Amgad N. Makaryus, MD
2 MD ;
.
1Donald
and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY and 2Department of Cardiology, Nassau University Medical Center, East Meadow, NY
Background • • • •
Coronavirus disease 2019 (COVID-19) has had a widereaching public health impact, contributing to over 4.6 million deaths globally as of October 2021. Previous studies have shown manifestations of cardiac disease in COVID-19 patients, including life-threatening arrhythmias. However, the underlying etiology and risk factors have not been well described. In this study, we examine the incidence of new-onset atrial fibrillation (AFB) and new-onset atrial flutter (AFL) among this vulnerable population and identify patient factors that may be associated with this phenomenon.
Results • 647 patients (mean age: 58.07; male sex: 59.35%) diagnosed with COVID-19 were included in this analysis. • 69 (10.66%) patients developed AFB or AFL during their hospital course, of which 41 (6.34%) were new-onset. • Among all COVID-19 patients, our adjusted model revealed that the development of sepsis (OR: 2.73; 95th% CI: 1.315.70; p=0.008) and age ≥65 years (OR: 5.43; 95th% CI: 2.3112.77; p<0.001) were associated with significantly higher odds of developing new-onset AFB or AFL.
Hypothesis • •
We hypothesize that our data will reveal a fair incidence of new-onset AFB and AFL among patients hospitalized with COVID-19. We further hypothesize that of our studied patients, those with a diagnosis of sepsis generally have worse outcomes and will therefore be more likely to develop new-onset AFB or AFL.
Methods • We conducted a retrospective single-center analysis (Nassau University Medical Center) on patients diagnosed with COVID19 from March 2020 to March 2021. • The number of individuals diagnosed with new-onset AFB or AFL during their hospital course was determined (those with a documented history of AFB or AFL were excluded). • Binary logistic regression, adjusted for race, sex, body mass index, and history of hypertension, coronary artery disease, diabetes mellitus, and chronic obstructive pulmonary disease, was performed to determine the association between newonset AFB or AFL and patient characteristics such as older age and disease course. • Patient race was categorized as White, African American, Asian, Central American Indian, Jamaican, Haitian, or Other. • The diagnosis of sepsis was made based on Sepsis-2 guidelines, while older age was defined as >65 years.
647 hospitalized COVID-19+ patients analyzed
69 patients diagnosed with AFB or AFL
41 patients determined to have new-onset AFB or AFL
Mean age: 58.07 years Male sex: 384 (59.4%) Sepsis: 117 (18.1%) Elderly: 237 (36.6%)
28 patients with prior history of AFB or AFL excluded
New-Onset AFB: 35 (85.4%) New-Onset AFL: 6 (14.6%) Sepsis: 15 (36.6%) Elderly: 29 (70.7%)
Figure 3. Flow diagram showing criteria to meet outcome of newonset AFB or AFL, as well as relevant demographics and results.
Conclusions Figure 1. A 76-year-old male hospitalized with COVID-19 progressed to septic shock during his disease course. EKG revealed atrial flutter with 2:1 block. This patient did not have a history of any prior arrhythmias and was therefore considered new-onset AFL related to COVID-19.
• Although COVID-19 was initially thought to be a localized respiratory illness, our study confirms previous reports that the disease can have grave cardiovascular manifestations. • Clinicians should be aware of the possibility of new-onset AFB or AFL in COVID-19 patients and be prepared to manage them should this occur. • It is crucial to consider that the odds of such a complication arising are increased over 2.5 times with the development of sepsis and over 5-fold in patients older than 65 years.
Future Direction
Figure 2. A 57-year-old female was hospitalized with COVID-19. EKG on admission revealed AFB with rapid ventricular response. The patient also did not have a history of any prior arrhythmias and was considered new-onset AFB related to COVID-19.
• Though our study shows that both septic and elderly COVID19 patients have significantly higher odds of developing newonset AFB or AFL, causation cannot be implied. • Further randomized studies are necessary to better elucidate this relationship, so that physicians can better identify and treat these high-risk patients.