open access

Ahead of print
Original Article
Published online: 2020-10-30
Get Citation

New-onset atrial fibrillation during COVID-19 infection predicts poor prognosis

Ana Pardo Sanz, Luisa Salido Tahoces, Rodrigo Ortega Pérez, Eduardo González Ferrer, Ángel Sanchez Recalde, José Luis Zamorano Gómez
DOI: 10.5603/CJ.a2020.0145
·
Pubmed: 33140386

open access

Ahead of print
Original articles
Published online: 2020-10-30

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has led to a paradigm shift in healthcare worldwide. Little is known about the impact on the cardiovascular system, and the incidence and consequences of new onset of atrial fibrillation (AF) in infected patients remain unclear. The aim of this study was to analyze the cardiovascular outcomes of patients with new-onset AF and coronavirus disease 2019 (COVID-19) infection.

Methods: This observational study analyzed a sample of 160 consecutive patients hospitalized due to COVID-19. A group with new-onset AF (n = 12) was compared with a control group (total: n = 148, sinus rhythm: n = 118, previous AF: n = 30). New-onset AF patients were significantly older and hypertensive, as well as presenting more frequently with a history of acute coronary syndrome and renal dysfunction. This group showed a higher incidence of thromboembolic events (41.7% vs. 4.1%; p < 0.001), bleeding (33.3% vs. 4.7%, p = 0.005), a combined endpoint of thrombosis and death (58.3 vs. 19.6%, p = 0.006) and longer hospital stays (16.4 vs. 8.6 days, p < 0.001), with no differences in all-cause mortality.

Results: In multivariate analysis, adjusted by potential confounding factors, new-onset AF demonstrated a 14.26 odds ratio for thromboembolism (95% confidence interval 2.86–71.10, p < 0.001).

Conclusions: New-onset AF in COVID-19 patients presumably has a notable impact on prognosis. The appearance of new-onset AF is related to worse cardiovascular outcomes, considering it as an independent predictor of embolic events. Further studies are needed to identify patients with COVID-19 at high risk of developing “de novo” AF, provide early anticoagulation and minimize the embolic risk of both entities.

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has led to a paradigm shift in healthcare worldwide. Little is known about the impact on the cardiovascular system, and the incidence and consequences of new onset of atrial fibrillation (AF) in infected patients remain unclear. The aim of this study was to analyze the cardiovascular outcomes of patients with new-onset AF and coronavirus disease 2019 (COVID-19) infection.

Methods: This observational study analyzed a sample of 160 consecutive patients hospitalized due to COVID-19. A group with new-onset AF (n = 12) was compared with a control group (total: n = 148, sinus rhythm: n = 118, previous AF: n = 30). New-onset AF patients were significantly older and hypertensive, as well as presenting more frequently with a history of acute coronary syndrome and renal dysfunction. This group showed a higher incidence of thromboembolic events (41.7% vs. 4.1%; p < 0.001), bleeding (33.3% vs. 4.7%, p = 0.005), a combined endpoint of thrombosis and death (58.3 vs. 19.6%, p = 0.006) and longer hospital stays (16.4 vs. 8.6 days, p < 0.001), with no differences in all-cause mortality.

Results: In multivariate analysis, adjusted by potential confounding factors, new-onset AF demonstrated a 14.26 odds ratio for thromboembolism (95% confidence interval 2.86–71.10, p < 0.001).

Conclusions: New-onset AF in COVID-19 patients presumably has a notable impact on prognosis. The appearance of new-onset AF is related to worse cardiovascular outcomes, considering it as an independent predictor of embolic events. Further studies are needed to identify patients with COVID-19 at high risk of developing “de novo” AF, provide early anticoagulation and minimize the embolic risk of both entities.

Get Citation

Keywords

new-onset atrial fibrillation, COVID-19 prognostic, SARS-CoV-2, embolism

About this article
Title

New-onset atrial fibrillation during COVID-19 infection predicts poor prognosis

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2020-10-30

DOI

10.5603/CJ.a2020.0145

Pubmed

33140386

Keywords

new-onset atrial fibrillation
COVID-19 prognostic
SARS-CoV-2
embolism

Authors

Ana Pardo Sanz
Luisa Salido Tahoces
Rodrigo Ortega Pérez
Eduardo González Ferrer
Ángel Sanchez Recalde
José Luis Zamorano Gómez

References (20)
  1. Meierhenrich R, Steinhilber E, Eggermann C, et al. Incidence and prognostic impact of new-onset atrial fibrillation in patients with septic shock: a prospective observational study. Crit Care. 2010; 14(3): R108.
  2. Zulkifly H, Lip GYH, Lane DA. Epidemiology of atrial fibrillation. Int J Clin Pract. 2018; 72(3): e13070.
  3. Driggin E, Madhavan MV, Bikdeli B, et al. Cardiovascular considerations for patients, health care workers, and health systems during the COVID-19 pandemic. J Am Coll Cardiol. 2020; 75(18): 2352–2371.
  4. Wang D, Hu Bo, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020; 323(11): 1061–1069.
  5. Lakkireddy DR, Chung MK, Gopinathannair R, et al. Guidance for Cardiac Electrophysiology During the Coronavirus (COVID-19) Pandemic from the Heart Rhythm Society COVID-19 Task Force. Hear Rhythm. 2020.
  6. Galvão Braga C, Ramos V, Vieira C, et al. New-onset atrial fibrillation during acute coronary syndromes: predictors and prognosis. Rev Port Cardiol. 2014; 33(5): 281–287.
  7. Mentias A, Saad M, Girotra S, et al. Impact of pre-existing and new-onset atrial fibrillation on outcomes after transcatheter aortic valve replacement. JACC Cardiovasc Interv. 2019; 12(21): 2119–2129.
  8. Kirchhof P, Benussi S, Kotecha D, et al. ESC Scientific Document Group. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016; 37(38): 2893–2962.
  9. Llitjos JF, Leclerc M, Chochois C, et al. High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients. J Thromb Haemost. 2020; 18(7): 1743–1746.
  10. Schulman S, Kearon C. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost. 2005; 3(4): 692–694.
  11. Bikdeli B, Madhavan MV, Jimenez D, et al. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up: JACC state-of-the-art review. J Am Coll Cardiol. 2020; 75(23): 2950–2973.
  12. Fan BE, Chong VC, Chan SS, et al. Hematologic parameters in patients with COVID-19 infection. Am J Hematol. 2020; 95(6): E131–E134.
  13. Mehta P, McAuley DF, Brown M, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020; 395(10229): 1033–1034.
  14. Chu G, Versteeg HH, Verschoor AJ, et al. Atrial fibrillation and cancer - An unexplored field in cardiovascular oncology. Blood Rev. 2019; 35: 59–67.
  15. Seguin P, Signouret T, Laviolle B, et al. Incidence and risk factors of atrial fibrillation in a surgical intensive care unit. Crit Care Med. 2004; 32(3): 722–726.
  16. Ozaydin M, Peker O, Erdogan D, et al. Oxidative status, inflammation, and postoperative atrial fibrillation with metoprolol vs carvedilol or carvedilol plus N-acetyl cysteine treatment. Clin Cardiol. 2014; 37(5): 300–306.
  17. DiNicolantonio JJ, Beavers CJ, Menezes AR, et al. Meta-analysis comparing carvedilol versus metoprolol for the prevention of postoperative atrial fibrillation following coronary artery bypass grafting. Am J Cardiol. 2014; 113(3): 565–569.
  18. Cook RC, Yamashita MH, Kearns M, et al. Prophylactic magnesium does not prevent atrial fibrillation after cardiac surgery: a meta-analysis. Ann Thorac Surg. 2013; 95(2): 533–541.
  19. Viviano A, Kanagasabay R, Zakkar M. Is perioperative corticosteroid administration associated with a reduced incidence of postoperative atrial fibrillation in adult cardiac surgery? Interact Cardiovasc Thorac Surg. 2014; 18(2): 225–229.
  20. Worden JC, Asare K. Postoperative atrial fibrillation: role of inflammatory biomarkers and use of colchicine for its prevention. Pharmacotherapy. 2014; 34(11): 1167–1173.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl