tetano
Editor, Senior Moderator
Circ Arrhythm Electrophysiol
. 2020 Oct 7.
doi: 10.1161/CIRCEP.120.008920. Online ahead of print.
Malignant Arrhythmias in Patients with COVID-19: Incidence, Mechanisms and Outcomes
Mohit K Turagam[SUP] 1 [/SUP], Daniel Musikantow[SUP] 1 [/SUP], Martin E Goldman[SUP] 2 [/SUP], Adel Bassily-Marcus[SUP] 3 [/SUP], Edward Chu[SUP] 1 [/SUP], Poojita Shivamurthy[SUP] 1 [/SUP], Joshua Lampert[SUP] 2 [/SUP], Iwanari Kawamura[SUP] 1 [/SUP], Mahmoud Bokhari[SUP] 1 [/SUP], William Whang[SUP] 1 [/SUP], Benjamin Aaron Bier[SUP] 2 [/SUP], Waqas Malick[SUP] 2 [/SUP], Helen Hashemi[SUP] 2 [/SUP], Marc A Miller[SUP] 1 [/SUP], Subbarao Choudry[SUP] 1 [/SUP], Christopher Pumill[SUP] 2 [/SUP], Tania Ruiz-Maya[SUP] 2 [/SUP], Michael Hadley[SUP] 2 [/SUP], Gennaro Giustino[SUP] 2 [/SUP], Jacob S Koruth[SUP] 1 [/SUP], Noelle Langan[SUP] 1 [/SUP], Aamir Sofi[SUP] 1 [/SUP], Srinivas R Dukkipati[SUP] 1 [/SUP], Jonathan L Halperin[SUP] 2 [/SUP], Valentin Fuster[SUP] 2 [/SUP], Roopa Kohli-Seth[SUP] 3 [/SUP], Vivek Y Reddy[SUP] 1 [/SUP]
Affiliations
Abstract
Background - Patients with coronavirus disease 2019 (COVID-19) who develop cardiac injury are reported to experience higher rates of malignant cardiac arrhythmias. However, little is known about these arrhythmias - their frequency, the underlying mechanisms, and their impact on mortality. Methods - We extracted data from a registry (NCT04358029) regarding consecutive inpatients with confirmed COVID-19, were receiving continuous telemetric ECG monitoring, and had a definitive disposition of hospital discharge or death. Between patients who died versus discharged, we compared a primary composite endpoint of cardiac arrest from ventricular tachycardia/fibrillation or bradyarrhythmias such as atrio-ventricular block. Results - Among 800 COVID-19 patients at Mount Sinai Hospital with definitive dispositions, 140 patients had telemetric monitoring and either died (52) or were discharged (88). The median (IQR) age was 61 years (48 - 74); 73% men; and ethnicity was Caucasian in 34%. Comorbidities included hypertension in 61%, coronary artery disease in 25%, ventricular arrhythmia history in 1.4%, and no significant comorbidities in 16%. Compared to discharged patients, those who died had elevated peak troponin I levels (0.27 vs 0.02 ng/mL), and more primary endpoint events (17% vs 4%, p = 0.01), a difference driven by tachyarrhythmias. Fatal tachyarrhythmias invariably occurred in the presence of severe metabolic imbalance, while atrioventricular block was largely an independent primary event. Conclusions - Hospitalized COVID-19 patients who die experience malignant cardiac arrhythmias more often than those surviving to discharge. However, these events represent a minority of cardiovascular deaths, and ventricular tachyarrhythmias are mainly associated with severe metabolic derangement.
. 2020 Oct 7.
doi: 10.1161/CIRCEP.120.008920. Online ahead of print.
Malignant Arrhythmias in Patients with COVID-19: Incidence, Mechanisms and Outcomes
Mohit K Turagam[SUP] 1 [/SUP], Daniel Musikantow[SUP] 1 [/SUP], Martin E Goldman[SUP] 2 [/SUP], Adel Bassily-Marcus[SUP] 3 [/SUP], Edward Chu[SUP] 1 [/SUP], Poojita Shivamurthy[SUP] 1 [/SUP], Joshua Lampert[SUP] 2 [/SUP], Iwanari Kawamura[SUP] 1 [/SUP], Mahmoud Bokhari[SUP] 1 [/SUP], William Whang[SUP] 1 [/SUP], Benjamin Aaron Bier[SUP] 2 [/SUP], Waqas Malick[SUP] 2 [/SUP], Helen Hashemi[SUP] 2 [/SUP], Marc A Miller[SUP] 1 [/SUP], Subbarao Choudry[SUP] 1 [/SUP], Christopher Pumill[SUP] 2 [/SUP], Tania Ruiz-Maya[SUP] 2 [/SUP], Michael Hadley[SUP] 2 [/SUP], Gennaro Giustino[SUP] 2 [/SUP], Jacob S Koruth[SUP] 1 [/SUP], Noelle Langan[SUP] 1 [/SUP], Aamir Sofi[SUP] 1 [/SUP], Srinivas R Dukkipati[SUP] 1 [/SUP], Jonathan L Halperin[SUP] 2 [/SUP], Valentin Fuster[SUP] 2 [/SUP], Roopa Kohli-Seth[SUP] 3 [/SUP], Vivek Y Reddy[SUP] 1 [/SUP]
Affiliations
- PMID: 33026892
- DOI: 10.1161/CIRCEP.120.008920
Abstract
Background - Patients with coronavirus disease 2019 (COVID-19) who develop cardiac injury are reported to experience higher rates of malignant cardiac arrhythmias. However, little is known about these arrhythmias - their frequency, the underlying mechanisms, and their impact on mortality. Methods - We extracted data from a registry (NCT04358029) regarding consecutive inpatients with confirmed COVID-19, were receiving continuous telemetric ECG monitoring, and had a definitive disposition of hospital discharge or death. Between patients who died versus discharged, we compared a primary composite endpoint of cardiac arrest from ventricular tachycardia/fibrillation or bradyarrhythmias such as atrio-ventricular block. Results - Among 800 COVID-19 patients at Mount Sinai Hospital with definitive dispositions, 140 patients had telemetric monitoring and either died (52) or were discharged (88). The median (IQR) age was 61 years (48 - 74); 73% men; and ethnicity was Caucasian in 34%. Comorbidities included hypertension in 61%, coronary artery disease in 25%, ventricular arrhythmia history in 1.4%, and no significant comorbidities in 16%. Compared to discharged patients, those who died had elevated peak troponin I levels (0.27 vs 0.02 ng/mL), and more primary endpoint events (17% vs 4%, p = 0.01), a difference driven by tachyarrhythmias. Fatal tachyarrhythmias invariably occurred in the presence of severe metabolic imbalance, while atrioventricular block was largely an independent primary event. Conclusions - Hospitalized COVID-19 patients who die experience malignant cardiac arrhythmias more often than those surviving to discharge. However, these events represent a minority of cardiovascular deaths, and ventricular tachyarrhythmias are mainly associated with severe metabolic derangement.