Clin Res Cardiol (2021)
DOI DOI https://doi.org/10.1007/s00392-021-01843-w
Arrhythmias in severe COVID-19 are less frequent than in critical pneumonias of other origin: results from a multicentre study
Z. Shomanova1, P. Jirak2, E. Fröb1, D. Dankl3, C. Torgersen3, N. Frank3, H. Haake4, M. Lichtenauer2, C. Pogoda1, J. Sindermann5, H. Reinecke1, U. C. Hoppe2, R. Larbig6, L. J. Motloch2, R. Pistulli1
1Klinik für Kardiologie I: Koronare Herzkrankheit, Herzinsuffizienz und Angiologie, Universitätsklinikum Münster, Münster; 2Klinik für Innere Med. II, Kardiologie u. intern. Intensivmedizin, Universitätsklinik der Salzburger Landeskliniken, Salzburg, AT; 3Klinik für Anästhesiologie, perioperative Medizin und allgemeine Intensivmedizin, Universitätsklinikum Salzburg, Salzburg, AT; 4Klinik für Kardiologie, Kliniken Maria Hilf, Mönchengladbach; 5Interdisziplinäre Sektion Herzinsuffizienz, Universitätsklinikum Münster, Münster; 6Klinik für Kardiologie und Int. Intensivmedizin, Krankenhaus St. Franziskus, Kliniken Maria Hilf GmbH, Mönchengladbach;

Aims: While myocardial injury is common in COVID-19 disease, arrhythmia episodes were reported in up to 30 % of hospitalized patients. Yet arrhythmias are also frequent in other types of critical pneumonias. In order to investigate whether this finding is specific for COVID-19, we compared their frequency in critically ill COVID-19 patients to patients with critical pneumonias of other origin. 

Methods: Our observational study included 124 patients requiring mechanical ventilation in three central European tertiary centres, including n=62 COVID-19 patients, matched to n=62 from a retrospective consecutive cohort of severe pneumonias of other origin (matched for age, gender, coronary artery disease and heart failure). We analysed all 12 lead-ECG and ECG monitoring for incidence and duration of any supraventricular and ventricular arrhythmia episodes.

Results: Arrhythmia episodes were very frequent in both groups, with a higher incidence in non-COVID-19 patients (COVID-19=43.5% vs. non-COVID-19=67.7%, p=0.007), consisting mostly of atrial fibrillation (AF) (COVID-19=21% vs. non-COVID-19=46.8%, p=0.002). Mean episode duration was also longer in the non-COVID-19 group (COVID-19=986 ± 5108 minutes vs. non-COVID-19=2233 ± 4979 minutes, p=0.001). Accordingly, electrical cardioversion/defibrillation was more frequent in non-COVID-19 (COVID-19=6.5% vs. non-COVID-19=19.4%, p=0.032). There was also a higher occurrence of atrial flutter and 1st degree AV-block in non-COVID-19 patients (atrial flutter COVID-19=1.6% vs. non-COVID-19=11.3%, p=0.028; 1st degree AV-block COVID-19=0% vs. non-COVID-19=6.5%, p=0.042). We did not find a significant difference in the occurrence of ventricular tachycardia (VTs) (nsVTs COVID-19=6.5% vs. non-COVID-19=4.8%, p=0.697; VTs COVID-19=3.2% vs. non-COVID-19=1.6%, p=0.559).

Conclusion: Supraventricular arrhythmias, mainly AF, is a common occurrence in severe COVID-19 disease. Yet, we found such to be even more frequent in matched critical pneumonias of different origin. Whether cardiac injury and arrhythmias are a specific characteristic of COVID-19 remains a topic of further research.

COVID-19 (n=)

NonCOVID-19 (n=)

n

Mean/Median±SD, or %

n

Mean/Median±SD or %

p-value

Gender (female)

15

24.2

15

24.2

1.000

Age (years)

62

66.98±12.67

62

66.21 ± 11.53

0.700

Any Arrhythmias

27

43.5

42

67.7

0.007

nsSVT

3

4.8

1

1.6

0.080

AF

13

21

29

46.8

0.002

Overall duration AF in minutes

59

986 ± 5108

62

2233 ± 4979

0.001

Other SVTs

Atrial flutter

AVNRT

1

1

1.6

1.6

7

1

11.3

1.6

0.028

1.000

Electrical

cardioversion/defibrillation

4

6.5

12

19.4

0.032

Sustained VTs or ventricular fibrillation

2

3.2

1

1.6

0.559

nsVT

4

6.5

3

4.8

0.697

Bradykardias

AV-block I°

Asystole

0

3

0

4.8

4

2

6.5

3.2

0.042

0.661
https://dgk.org/kongress_programme/jt2021/aP1388.html