New research suggests that although critically ill patients admitted to the intensive care unit (ICU) with coronavirus disease 2019 (COVID-19) are 10 times more likely to develop cardiac arrhythmias, this development is likely caused by systemic illness rather than by the viral infection alone.

The study findings are significantly different from early COVID-19 reports, which showed a high incidence of arrhythmias among all patients with the disease. According to a press release, the new study aims to provide more clarity about the role of the virus in the development of atrial fibrillation, bradyarrhythmia, and non-sustained ventricular tachycardia.

“In order to best protect and treat patients who develop COVID-19, it’s critical for us to improve our understanding of how the disease affects various organs and pathways within our body—including our heart rhythm abnormalities,” said senior author Rajat Deo, MD, MTR, in a statement. “Our findings suggest that non-cardiac causes such as systemic infection, inflammation, and illness are likely to contribute more to the occurrence of cardiac arrest and arrhythmias than damaged or infected heart cells due to the viral infection.”

To evaluate this risk among patients with COVID-19, investigators at the Perelman School of Medicine at the University of Pennsylvania evaluated 700 patients with COVID-19 who were admitted to the Hospital of the University of Pennsylvania between early March and mid-May 2020. They evaluated cardiac telemetry and clinical records for patients’ demographics and comorbidities, and recorded patient vitals, test results, and treatments.

The patients had a mean age of 50 years and more than 70% were Black. The investigators found 53 arrhythmic events, including 9 events of cardiac arrest, 25 patients with atrial fibrillation requiring treatment, 9 patients with clinically significant bradyarrhythmias, and 10 non-sustained ventricular tachycardia events. They found no cases of heart block, sustained ventricular tachycardia, or ventricular fibrillation.

Of the 700 hospitalized patients, approximately 11% entered the ICU. Only that population suffered any cardiac arrests. Furthermore, after controlling for underlying demographic and clinical factors, the investigators found that cardiac arrest and arrhythmias were more likely to occur among patients in the ICU compared with other hospitalized patients.

“More research is needed to assess whether the presence of cardiac arrhythmias have long-term health effects on patients who were hospitalized for COVID-19,” Deo concluded. “In the meantime, it’s important that we launch studies to evaluate the most effective and safest strategies for long-term anticoagulation and rhythm management in this population.”

REFERENCE
Critically Ill Patients with COVID-19 Are More Likely to Develop Heart Rhythm Disorders Than Other Hospitalized Patients with the Disease [news release]. Penn Medicine; June 22, 2020. https://www.pennmedicine.org/news/news-releases/2020/june/critically-ill-patients-with-covid-19-are-more-likely-to-develop-heart-rhythm-disorders. Accessed July 7, 2020.