COVID-19 and cardiac arrhythmias
COVID-19 and cardiac arrhythmias
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DOI：
10.1016/j.hrthm.2020.06.016
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发表时间：
2020-09-01
期刊：
影响因子：
5.5
通讯作者：
Deo, Rajat
中科院分区：
文献类型：
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作者：
Bhatla, Anjali;Mayer, Michael M.;Deo, Rajat
早期研究表明，冠状病毒病2019 （COVID-19）与心律失常的高发有关。严重急性呼吸综合征冠状病毒2型感染可引起心肌细胞损伤，增加心律失常风险。本研究的目的是评估因COVID-19住院的大型城市人群发生心脏骤停和心律失常的风险，包括房颤（AF）、慢速性心律失常和非持续性室性心动过速（NSVT）。我们还评估了这些心律失常的存在与死亡率之间的相关性。方法我们回顾了在9周内入院的所有COVID-19患者的特征。在整个住院期间，我们评估了心脏骤停、心律失常和住院病人死亡率的发生率。我们还使用logistic回归来评估年龄、性别、种族、体重指数、流行心血管疾病、糖尿病、高血压、慢性肾脏疾病和重症监护病房（ICU）状态作为每种心律失常的潜在危险因素。结果在700例患者中（平均年龄50 ~ 18岁，45%为男性，71%为非洲裔美国人，11%接受过ICU护理），有9例心脏骤停，25例房颤事件，9例有临床意义的慢速心律失常，10例非室性心动过速。所有的心脏骤停都发生在ICU的患者中。此外，经多变量调整后，入住ICU与AF事件（比值比[OR] 4.68； 95%可信区间[CI] 1.66-13.18）和NSVT（比值比[OR] 8.92; 95% CI 1.73-46.06）相关。此外，年龄和AF事件（OR 1.05; 95% CI 1.02- 1.09）以及普遍的心力衰竭和慢速心律失常（OR 9.75; 95% CI 1.95-48.65）是独立相关的。只有心脏骤停与急性住院死亡率相关。结论心脏骤停和心律失常可能是全身性疾病的结果，而不仅仅是COVID-19感染的直接影响。
BACKGROUND Early studies suggest that coronavirus disease 2019 (COVID-19) is associated with a high incidence of cardiac arrhythmias. Severe acute respiratory syndrome coronavirus 2 infection may cause injury to cardiac myocytes and increase arrhythmia risk.OBJECTIVES The purpose of this study was to evaluate the risk of cardiac arrest and arrhythmias including incident atrial fibrillation (AF), bradyarrhythmias, and nonsustained ventricular tachycardia (NSVT) in a large urban population hospitalized for COVID-19. We also evaluated correlations between the presence of these arrhythmias and mortality.METHODS We reviewed the characteristics of all patients with COVID-19 admitted to our center over a 9-week period. Throughout hospitalization, we evaluated the incidence of cardiac arrests, arrhythmias, and inpatient mortality. We also used logistic regression to evaluate age, sex, race, body mass index, prevalent cardiovascular disease, diabetes, hypertension, chronic kidney disease, and intensive care unit (ICU) status as potential risk factors for each arrhythmia.RESULTS Among 700 patients (mean age 50 6 18 years; 45% men; 71% African American; 11% received ICU care), there were 9 cardiac arrests, 25 incident AF events, 9 clinically significant bradyarrhythmias, and 10 NSVTs. All cardiac arrests occurred in patients admitted to the ICU. In addition, admission to the ICU was associated with incident AF (odds ratio [OR] 4.68; 95% confidence interval [CI] 1.66-13.18) and NSVT (OR 8.92; 95% CI 1.73-46.06) after multivariable adjustment. Also, age and incident AF (OR 1.05; 95% CI 1.02- 1.09) and prevalent heart failure and bradyarrhythmias (OR 9.75; 95% CI 1.95-48.65) were independently associated. Only cardiac arrests were associated with acute in-hospital mortality.CONCLUSION Cardiac arrests and arrhythmias are likely the consequence of systemic illness and not solely the direct effects of COVID-19 infection.