Objective:

Critically ill patients affected with COVID-19 seem to be prone to the development of tachycardic and bradycardic arrhythmias. The objective of this trial was to determine characteristics, clinical significance and therapeutic consequences of these arrhythmias in patients hospitalized with COVID-19 requiring ICU treatment.

Methods and Results

In this prospective, observational trial a total of 113 consecutive patients (mean age 64.1±14.3 years, 30(26.5%) female) with positive PCR testing for SARS-CoV2 as well as radiographically confirmed pulmonary involvement admitted to the intensive care unit (ICU) were included. During the observational period fifty episodes of sustained atrial tachycardias, five episodes of sustained ventricular arrhythmias and thirty bradycardic events were documented.

Sustained new onset atrial arrhythmias were associated with hemodynamic deterioration in 13 cases (35.1%). Patients with new onset atrial arrhythmias were older, showed higher levels of Hs-Troponin and NT-proBNP, and a more severe course of disease.

The 5 ventricular arrhythmias (two ventricular tachycardias, two episodes of ventricular fibrillation, and one torsade de pointes tachycardia) were observed in 4 patients. All episodes could be terminated by immediate defibrillation/cardioversion.

Five bradycardic events were associated with hemodynamic deterioration. Precipitating factors could be identified in 19 of 30 episodes (63.3%), no patient required cardiac pacing. Baseline characteristics were not significantly different between patients with or without bradycardic events.

Conclusion

Relevant arrhythmias are common in severely ill ICU patients affected with COVID-19. They are associated with worse courses of disease and require specific treatment. This makes daily close monitoring of telemetric data mandatory in this patient group.