For patients with coronavirus disease 2019 (COVID-19), the combination of the disease and preexisting atrial arrhythmias may create a pathologic synergy that significantly increases the risk for major adverse cardiac events and death, according to a presentation at the American Heart Association’s Scientific Sessions 2020.

Prior studies indicate that patients with COVID-19 with evidence of heart damage have higher death rates, according to the current study. Evidence of heart damage can present as abnormal heart rhythms, such as atrial fibrillation and atrial flutter. Specifically, atrial fibrillation is a common form of heart arrhythmias and independently increases the risk factor for death.

In order to investigate the prevalence and outcomes of hospitalized COVID-19 patients with atrial fibrillation and atrial flutter, the researchers analyzed data from 435 patients over 18 years of age from medical records in the Yale Cardiovascular COVID-19 Registry. All patients included in the study were admitted to the hospital between March and June 2020 in the Yale New Haven Health System.

The results demonstrated that 7.8% patients were diagnosed with atrial fibrillation/flutter for the first time in their lives while hospitalized, and 15.9% of the patients had a prior history of these types of arrhythmia. In total, one-fifth of the patients assessed had an episode of atrial fibrillation/flutter while they were hospitalized for COVID-19.

Additionally, the data demonstrated that patients with a prior history of atrial fibrillation/flutter had a significantly higher risk of death or intensive care unit (ICU) mortality, independent of other health issues in the heart, kidneys, and lungs.

In-hospital atrial arrhythmias were also found to be significantly associated with even greater risk of death and ICU mortality, as well as multi-organ failure, such as respiratory failure and renal failure.

"Our study suggests that the combination of COVID-19 and atrial arrhythmias may create a pathologic synergy that markedly increases the risk for major adverse cardiac events and death," said lead author of the study Zaniar Ghazizadeh, MD, an internal medicine resident at Yale New Haven Hospital/Yale School of Medicine, in a press release. "COVID-19 places patients at a high risk for abnormal heart rhythms that are, in turn, associated with markedly worse outcomes including death and multi-organ failure. Patients and physicians need to monitor for these arrhythmias closely and treatments needs to be timely."

COVID-19 risks: Irregular heartbeat may increase risk, blood pressure medicines do not. Dallas, TX: American Heart Association; November 9, 2020. Accessed November 17, 2020.