Atrial Fibrillation in Patients Hospitalized With COVID-19: Incidence, Predictors, Outcomes, and Comparison to Influenza

Daniel R Musikantow; Mohit K Turagam; Samantha Sartori; Edward Chu; Iwanari Kawamura; Poojita Shivamurthy; Mahmoud Bokhari; Connor Oates; Chi Zhang; Christopher Pumill; Waqas Malick; Helen Hashemi; Tania Ruiz-Maya; Michael B Hadley; Jonathan Gandhi; Dylan Sperling; William Whang; Jacob S Koruth; Marie-Noelle Langan; Aamir Sofi; Anthony Gomes; Stephanie Harcum; Sam Cammack; Betsy Ellsworth; Srinivas R Dukkipati; Adel Bassily-Marcus; Roopa Kohli-Seth; Martin E Goldman; Jonathan L Halperin; Valentin Fuster; Vivek Y Reddy

doi:10.1016/j.jacep.2021.02.009

Atrial Fibrillation in Patients Hospitalized With COVID-19: Incidence, Predictors, Outcomes, and Comparison to Influenza

JACC Clin Electrophysiol. 2021 Sep;7(9):1120-1130. doi: 10.1016/j.jacep.2021.02.009. Epub 2021 Feb 24.

Authors

Daniel R Musikantow¹, Mohit K Turagam¹, Samantha Sartori¹, Edward Chu¹, Iwanari Kawamura¹, Poojita Shivamurthy¹, Mahmoud Bokhari¹, Connor Oates¹, Chi Zhang¹, Christopher Pumill¹, Waqas Malick¹, Helen Hashemi¹, Tania Ruiz-Maya¹, Michael B Hadley¹, Jonathan Gandhi¹, Dylan Sperling¹, William Whang², Jacob S Koruth², Marie-Noelle Langan², Aamir Sofi², Anthony Gomes², Stephanie Harcum², Sam Cammack², Betsy Ellsworth², Srinivas R Dukkipati², Adel Bassily-Marcus³, Roopa Kohli-Seth³, Martin E Goldman¹, Jonathan L Halperin¹, Valentin Fuster¹, Vivek Y Reddy⁴

Affiliations

¹ Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
² Department of Cardiovascular Medicine, Helmsley Electrophysiology Center, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
³ Department of Critical Care Medicine, Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁴ Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Helmsley Electrophysiology Center, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Electronic address: vivek.reddy@mountsinai.org.

Abstract

Objectives: The goal of this study is to determine the incidence, predictors, and outcomes of atrial fibrillation (AF) or atrial flutter (AFL) in patients hospitalized with coronavirus disease-2019 (COVID-19).

Background: COVID-19 results in increased inflammatory markers previously associated with atrial arrhythmias. However, little is known about their incidence or specificity in COVID-19 or their association with outcomes.

Methods: This is a retrospective analysis of 3,970 patients admitted with polymerase chain reaction-positive COVID-19 between February 4 and April 22, 2020, with manual review performed of 1,110. The comparator arm included 1,420 patients with influenza hospitalized between January 1, 2017, and January 1, 2020.

Results: Among 3,970 inpatients with COVID-19, the incidence of AF/AFL was 10% (n = 375) and in patients without a history of atrial arrhythmias it was 4% (n = 146). Patients with new-onset AF/AFL were older with increased inflammatory markers including interleukin 6 (93 vs. 68 pg/ml; p < 0.01), and more myocardial injury (troponin-I: 0.2 vs. 0.06 ng/ml; p < 0.01). AF and AFL were associated with increased mortality (46% vs. 26%; p < 0.01). Manual review captured a somewhat higher incidence of AF/AFL (13%, n = 140). Compared to inpatients with COVID-19, patients with influenza (n = 1,420) had similar rates of AF/AFL (12%, n = 163) but lower mortality. The presence of AF/AFL correlated with similarly increased mortality in both COVID-19 (relative risk: 1.77) and influenza (relative risk: 1.78).

Conclusions: AF/AFL occurs in a subset of patients hospitalized with either COVID-19 or influenza and is associated with inflammation and disease severity in both infections. The incidence and associated increase in mortality in both cohorts suggests that AF/AFL is not specific to COVID-19, but is rather a generalized response to the systemic inflammation of severe viral illnesses.

Keywords: atrial fibrillation; atrial flutter; coronavirus disease-2019; influenza; ischemic stroke.

MeSH terms

Atrial Fibrillation* / epidemiology
COVID-19*
Humans
Incidence
Influenza, Human* / epidemiology
Retrospective Studies
Risk Factors
SARS-CoV-2