Infectious Disease

AF, atrial flutter in COVID-19 could also be linked to irritation

March 04, 2021

2 min read

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Reddy does not report any relevant financial information. In the study you will find all relevant financial information from all other authors.

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Emerging atrial fibrillation and atrial flutter are just as common in hospitalized patients with influenza as they are in COVID-19, suggesting that the association between the arrhythmias and COVID-19 is related to the general state of inflammation.

Although COVID-19 was known to increase markers of inflammation associated with atrial arrhythmias, the relationship of inflammation to COVID-19 was unknown. Therefore, the researchers performed a retrospective analysis that compared the incidence, predictors, and outcomes of AF or atrial flutter in patients with COVID-19 and patients with influenza, another viral disease that increases markers of inflammation.

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Vivek YY Reddy

“When we started it wasn’t clear whether the SARS-CoV-2 virus actually had a direct effect on the myocardium and caused arrhythmias. One way to look into this was to see if another serious respiratory disease, not COVID, had affected people and increased their atrial fibrillation and mortality. ” Vivek YY Reddy, MD, The director of arrhythmias at Mount Sinai Hospital and the Mount Sinai Health System, as well as the Leona M. and Harry B. Helmsley Charitable Trust, professor of medicine of cardiac electrophysiology at the Icahn School of Medicine on Mount Sinai, said Healio.

“A negative biomarker”

Reddy said the researchers found that AF also occurred in patients with influenza and contributed to an increase in their mortality.

“From a relative standpoint, AF appears to be a significant independent negative biomarker that predicts mortality. The fact that it occurs in both COVID and influenza is more in line with the mechanism that worse outcomes are due to the generalized bad inflammatory state rather than something very specific to COVID, “Reddy told Healio.

Among 3,970 patients with COVID-19 admitted to Mount Sinai System hospitals from February 4 to April 22, 2020 (mean age 66 years; 59% men), 10% had atrial fibrillation or flutter and those with no history Atrial arrhythmias, 4% had AF or atrial flutter, the researchers wrote, noting that in a manual review of 1,110 patients, the incidence rate of AF or atrial flutter was 13%.

Among those with COVID-19, patients with emerging atrial fibrillation or atrial flutter were older, had elevated markers of inflammation, including interleukin-6 (93 pg / ml versus 68 pg / ml; P <0.01), had more severe myocardial injury such as troponin I. (0.2 ng / ml vs. 0.06 ng / ml; P <0.01) and had higher mortality rates (46% vs. 26%; P <0.01) compared to those without newly occurring AF or Atrial flutter, according to the researchers.

Among 1,420 influenza patients admitted to hospital from 2017 to January 1, 2020 (mean age 66 years; 42% men), the rate of AF or atrial flutter was 12% (P vs. COVID-19 cohort = 0, 03) and the rate of emerging AF or atrial flutter was 4% (P vs. COVID-19 cohort = 0.93), the researchers wrote, although the absolute hospital death rate was lower in the influenza cohort than in the COVID-19 cohort (9% versus 29%; P <0.01).

The presence of AF or atrial flutter correlated with worsened mortality in both the COVID-19 cohort (RR = 1.77) and the influenza cohort (RR = 1.78), Reddy and colleagues wrote.

High risk population

The takeaway news from the study is that a patient hospitalized with COVID-19 or influenza who develops AF is at very high risk, Reddy said in an interview.

“We believe that this worsened outcome with AF in these patients is likely not related to a direct myocardial effect of the viral disease state, but rather to the generalized inflammatory situation,” Reddy told Healio.

Reddy noted that stepping up therapy, whether using anti-inflammatories, antivirals, or a combination, should be considered in patients hospitalized with COVID-19 and an atrial arrhythmia.

For more informations:

Vivek YY Reddy, MD, can be reached at vivek.reddy@mountsinai.org.

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