番茄社区

It was common for COVID-19 patients with severe illness to develop an atrial arrhythmia, according to a research group in Alabama.

Of the 115 patients admitted to the University of Alabama at Birmingham (UAB) Hospital from Feb. 29 to April 10 of this year with confirmed infection with SARS-CoV-2, the virus that causes COVID-19, 16.5% developed an atrial tachyarrhythmia that had not been present on admission, reported Chad Colon, MD, and other UAB colleagues.

Specifically, as they noted in their study, published as a research letter online in , atrial fibrillation (Afib) was noted in 12 people, atrial flutter in six, and atrial tachycardia in one; all these patients were in the medical intensive care unit (ICU).

Vasopressors were required to support blood pressure at some point for 15 of the 19 COVID-19 patients with atrial arrhythmias. Ten of the 19 experienced hemodynamic compromise within 1 hour of arrhythmia onset: nine patients required initiation or an increased dose of vasopressors and one required immediate direct current cardioversion.

"Atrial arrhythmias are common among patients with COVID-19 who require admission to an intensive care unit and are often followed by hemodynamic deterioration. These arrhythmias complicate the course of the more severely ill patients with this infection," Colon and colleagues concluded.

Ultimately, five of the 19 patients with atrial arrhythmias died. Ten were discharged in sinus rhythm and four in Afib.

"We often see Afib as a fellow traveler in medical ICU settings – it is common to see this in sick patients, especially those with risk factors for Afib or a previous history of the arrhythmia," commented Dan Roden, MDCM, of Vanderbilt University Medical Center in Nashville, who was not involved with the study.

"This paper supports the idea that sick patients do develop Afib, that it can be hemodynamically and clinically destabilizing, and that it is either a marker for a poor outcome or contributes to poor outcomes," he told 番茄社区.

Colon's group had analyzed the records of COVID-19 patients admitted to the center during the study period. The researchers counted 69 people who had been admitted to the medical ICU and 46 others who had gone to a general medicine ward.

Overall, the mean age of the patients was 56, over half the cohort were men, and black individuals also accounted for more than half the group.

The comorbidity burden of the patients included hypertension (70%), current or former tobacco use (42%), diabetes (39%), coronary artery disease (16%), chronic kidney disease (14%), and chronic obstructive lung disease (13%).

Compared with those who did not develop atrial tachyarrhythmias, those who did tended to be older with higher concentrations of C-reactive protein and d-dimer. Atrial tachyarrhythmias were also associated with a person's need for ventilation.

Patients with and without atrial arrhythmias were similarly likely to have used angiotensin converting enzyme inhibitors and angiotensin receptor blockers, as well as remdesivir, hydroxychloroquine (Plaquenil), and azithromycin.

Atrial arrhythmias were treated with intravenous amiodarone in nine patients (with seven converting to sinus rhythm). One patient who received direct current cardioversion reverted to Afib within minutes. Because of contraindications including bleeding, anticoagulation was administered to only 12 of 19 patients, Colon's team noted.

Roden commented that he would have liked to see what the data looked like in non-COVID patients, namely those with other severe viral infections or other pneumonias.

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