Since the first reports in Wuhan province, China of patients infected with the new virus “Severe Acute Respiratory Syndrome coronavirus 2” (SARS-CoV-2), the majority of these patients presented mild or moderate respiratory symptoms. However, a significant proportion suffered cardiovascular complications, with the spotlight being on heart arrhythmias.
We analysed the results of 518 patients with a positive diagnosis of SARS-CoV-2. 94.3% developed severe pneumonia, the median age was 70 (IQR: 59–79), the most frequent personal pathological antecedents were high blood pressure and obesity. While 87.7% received invasive mechanical ventilation, 147 patients (28.4%) presented heart arrhythmias, and 63.4% of them were atrial fibrillation (AF).
A multivariate analysis was performed to determine the correlation of certain variables with the occurrence of heart arrhythmias. Age and creatinine value were identified as triggering factors for heart arrhythmias with RR: 1.04; (95% CI: 1.02–1.06; P < .001) and RR: 1.01; (CI: 1.00–1.01; P < .001) respectively (Fig. 1). The same variables acquire statistical significance for AF, the most repeated arrhythmia in the study (Fig. 1).
In-hospital survival among critically ill hospitalised patients with COVID-19 did not reveal significant differences between the group that presented heart arrhythmias and those that did not (P = .488). The same happened when analysing the survival rate between the group of patients with AF episodes and those who did not present them during their hospitalisation (P = 0.631).
In this study, AF was the most common heart arrhythmia reaching about 20% among hospitalised patients with COVID-19, and this is similar to the results of other studies, especially in hospitalised patients with severe infections. In the context of COVID-19 infection, the relationship between age and the occurrence of heart arrhythmias is significant. The increase in age by one year was associated with episodes of AF among patients treated in Intensive Care Units (ICU) according to the results of the studies by Bhatla et al.1
As shown in the results, patients with elevated creatinine values were associated with episodes of heart arrhythmias, specifically AF. Acute inflammation in patients infected with SARS-CoV-2, renal tissue damage, and volume overload, all contribute to the occurrence of heart arrhythmias.2 The study by Bagnato et al.3 in hospitalised patients with a positive diagnosis of COVID-19 concluded that the new AF episodes were associated with elevated creatinine and urea values. Similarly, a study that evaluated the impact of COVID-19 on the occurrence of heart arrhythmias found a significant association with elevated creatinine values.4 Granja-García et al.5 in a study in patients with SARS-CoV-2, addressed the relationship of different laboratory variables, including creatinine, with AF episodes in hospitalised patients.
Heart arrhythmias represent the most frequent cardiovascular complications, with AF leading the group. Advanced age and creatinine values were identified as independent predictor variables of heart arrhythmias and AF in patients admitted to the ICUs with severe COVID-19 disease. It is especially important to incorporate cardiology specialists in the care of patients admitted for this disease.
