Worldwide Survey of COVID-19–Associated Arrhythmias

Author:

Coromilas Ellie J.1ORCID,Kochav Stephanie1,Goldenthal Isaac1ORCID,Biviano Angelo1ORCID,Garan Hasan1,Goldbarg Seth2ORCID,Kim Joon-Hyuk2,Yeo Ilhwan2,Tracy Cynthia3,Ayanian Shant3,Akar Joseph4ORCID,Singh Avinainder4ORCID,Jain Shashank4ORCID,Zimerman Leandro5ORCID,Pimentel Maurício5ORCID,Osswald Stefan6ORCID,Twerenbold Raphael6ORCID,Schaerli Nicolas6ORCID,Crotti Lia78ORCID,Fabbri Daniele78,Parati Gianfranco78ORCID,Li Yi9ORCID,Atienza Felipe1011ORCID,Zatarain Eduardo1011ORCID,Tse Gary121314ORCID,Leung Keith Sai Kit15ORCID,Guevara-Valdivia Milton E.16ORCID,Rivera-Santiago Carlos A.16ORCID,Soejima Kyoko17,De Filippo Paolo18ORCID,Ferrari Paola18ORCID,Malanchini Giovanni18ORCID,Kanagaratnam Prapa19ORCID,Khawaja Saud19,Mikhail Ghada W.19,Scanavacca Mauricio20ORCID,Abrahão Hajjar Ludhmila20,Rizerio Brenno20ORCID,Sacilotto Luciana20ORCID,Mollazadeh Reza21ORCID,Eslami Masoud21,Laleh far Vahideh21ORCID,Mattioli Anna Vittoria22ORCID,Boriani Giuseppe22ORCID,Migliore Federico23ORCID,Cipriani Alberto23ORCID,Donato Filippo23ORCID,Compagnucci Paolo24ORCID,Casella Michela24ORCID,Dello Russo Antonio24,Coromilas James25ORCID,Aboyme Andrew25ORCID,O’Brien Connor Galen26ORCID,Rodriguez Fatima27ORCID,Wang Paul J.27ORCID,Naniwadekar Aditi28ORCID,Moey Melissa28ORCID,Kow Chia Siang29,Cheah Wee Kooi30,Auricchio Angelo31ORCID,Conte Giulio31ORCID,Hwang Jongmin32ORCID,Han Seongwook32,Lazzerini Pietro Enea3334ORCID,Franchi Federico3334ORCID,Santoro Amato3334ORCID,Capecchi Pier Leopoldo3334ORCID,Joglar Jose A.35ORCID,Rosenblatt Anna G.35ORCID,Zardini Marco36ORCID,Bricoli Serena36ORCID,Bonura Rosario36ORCID,Echarte-Morales Julio37,Benito-González Tomás37ORCID,Minguito-Carazo Carlos37ORCID,Fernández-Vázquez Felipe37ORCID,Wan Elaine Y.1ORCID

Affiliation:

1. Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians & Surgeons (E.J.C., S. Kochav, I.G., A.B., H.G., E.Y.W.).

2. New York Presbyterian Queens, Weill Medical College (S.G., J.-H.K., I.Y.).

3. The George Washington University School of Medicine & Health Sciences, The GW Medical Faculty Associates, Washington, DC (C.T., S.A.).

4. Section of Cardiovascular Disease, Yale University School of Medicine, New Haven, CT (J.A., A. Singh, S.J.).

5. Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil (L.Z., M.P.).

6. Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland (S.O., R.T., N.S.).

7. Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural & Metabolic Sciences, San Luca Hospital, Milan, Italy (L.C., D.F., G.P.).

8. Department of Medicine & Surgery, University of Milano-Bicocca, Milan, Italy (L.C., D.F., G.P.).

9. Wuhan Asia General Hospital, China (Y.L.).

10. Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) (F.A., E.Z.).

11. CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain (F.A., E.Z.).

12. Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, China (G.T.).

13. School of Life Sciences. The Hospital Authority of Hong Kong, Hong Kong, China (G.T.).

14. Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Hong Kong, China (G.T.).

15. Aston Medical School, Aston University, Birmingham, United Kingdom (K.C.K.L.).

16. UMAE Hospital de Especialidades Dr. Antonio Fraga Mouret CMN La Raza IMSS, CDMX, Mexico (M.E.G.-V., C.A.R.-S.).

17. Kyorin University School of Medicine, Tokyo, Japan (K.S.).

18. Electrophysiology & Cardiac Pacing Unit, Cardiology Department, ASST Papa Giovanni XXIII, Bergamo, Italy (P.D.F., P.F., G.M.).

19. Imperial College Healthcare NHS Trust, London, United Kingdom (P.K., S. Khawaja, G.W.M.).

20. Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (M.S., A.H., B.R., L.S.).

21. Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Iran (R.M., M.E., V.L.f.).

22. University of Modena & Reggio Emilia, Modena, Italy (V.M., G.B.).

23. Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.C., F.D.).

24. Cardiology & Arrhythmology Clinic, University Hospital “Ospedali Riuniti,” Marche Polytechnic University, Ancona, Italy (P.C., M.C., A.D.R.).

25. Division of Cardiovascular Disease & Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (J.C., A. Aboyme).

26. Department of Medicine, Division of Cardiology, University of California San Francisco School of Medicine (C.G.O.).

27. Division of Cardiology, Stanford University, CA (F.R., P.J.W.).

28. East Carolina University, Greenville, NC (A.N., M.M.).

29. School of Postgraduate Studies, International Medical University, Kuala Lumpur (C.S.K.).

30. Department of Medicine & Clinical Research Center, Taiping Hospital, Perak, Malaysia (W.K.C.).

31. Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A. Auricchio, G.C.).

32. Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea (J.H., S.H.).

33. Department of Medical Sciences, Surgery & Neurosciences, University of Siena, Italy (P.E.L., F.F., A. Santoro, P.L.C.).

34. Azienda Ospedaliera Universitaria Senese (AOUS), Siena, Italy (P.E.L., F.F., A. Santoro, P.L.C.).

35. University of Texas Southwestern Medical Center, Dallas (J.A.G., A.G.R.).

36. Division of Cardiology, University Hospital “Ospedale Maggiore,” Parma, Italy (M.Z., S.B., R.B.).

37. Department of Cardiology, University Hospital of Leon, Spain (J.E.-M., T.B.-G., C.M.-C., F.F.-V.).

Abstract

Background: Coronavirus disease 2019 (COVID-19) has led to over 1 million deaths worldwide and has been associated with cardiac complications including cardiac arrhythmias. The incidence and pathophysiology of these manifestations remain elusive. In this worldwide survey of patients hospitalized with COVID-19 who developed cardiac arrhythmias, we describe clinical characteristics associated with various arrhythmias, as well as global differences in modulations of routine electrophysiology practice during the pandemic. Methods: We conducted a retrospective analysis of patients hospitalized with COVID-19 infection worldwide with and without incident cardiac arrhythmias. Patients with documented atrial fibrillation, atrial flutter, supraventricular tachycardia, nonsustained or sustained ventricular tachycardia, ventricular fibrillation, atrioventricular block, or marked sinus bradycardia (heart rate<40 bpm) were classified as having arrhythmia. Deidentified data was provided by each institution and analyzed. Results: Data were collected for 4526 patients across 4 continents and 12 countries, 827 of whom had an arrhythmia. Cardiac comorbidities were common in patients with arrhythmia: 69% had hypertension, 42% diabetes, 30% had heart failure, and 24% had coronary artery disease. Most had no prior history of arrhythmia. Of those who did develop an arrhythmia, the majority (81.8%) developed atrial arrhythmias, 20.7% developed ventricular arrhythmias, and 22.6% had bradyarrhythmia. Regional differences suggested a lower incidence of atrial fibrillation in Asia compared with other continents (34% versus 63%). Most patients in North America and Europe received hydroxychloroquine, although the frequency of hydroxychloroquine therapy was constant across arrhythmia types. Forty-three percent of patients who developed arrhythmia were mechanically ventilated and 51% survived to hospital discharge. Many institutions reported drastic decreases in electrophysiology procedures performed. Conclusions: Cardiac arrhythmias are common and associated with high morbidity and mortality among patients hospitalized with COVID-19 infection. There were significant regional variations in the types of arrhythmias and treatment approaches.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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