Malignant Arrhythmias in Patients With COVID-19: Incidence, Mechanisms, and Outcomes

Mohit K Turagam, Daniel Musikantow, Martin E Goldman, Adel Bassily-Marcus, Edward Chu, Poojita Shivamurthy, Joshua Lampert, Iwanari Kawamura, Mahmoud Bokhari, William Whang, Benjamin Aaron Bier, Waqas Malick, Helen Hashemi, Marc A Miller, Subbarao Choudry, Christopher Pumill, Tania Ruiz-Maya, Michael Hadley, Gennaro Giustino, Jacob S Koruth, Noelle Langan, Aamir Sofi, Srinivas R Dukkipati, Jonathan L Halperin, Valentin Fuster, Roopa Kohli-Seth, Vivek Y Reddy, Mohit K Turagam, Daniel Musikantow, Martin E Goldman, Adel Bassily-Marcus, Edward Chu, Poojita Shivamurthy, Joshua Lampert, Iwanari Kawamura, Mahmoud Bokhari, William Whang, Benjamin Aaron Bier, Waqas Malick, Helen Hashemi, Marc A Miller, Subbarao Choudry, Christopher Pumill, Tania Ruiz-Maya, Michael Hadley, Gennaro Giustino, Jacob S Koruth, Noelle Langan, Aamir Sofi, Srinivas R Dukkipati, Jonathan L Halperin, Valentin Fuster, Roopa Kohli-Seth, Vivek Y Reddy

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 who 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 end point of cardiac arrest from ventricular tachycardia/fibrillation or bradyarrhythmias such as atrioventricular block.

Results: Among 800 patients with COVID-19 at Mount Sinai Hospital with definitive dispositions, 140 patients had telemetric monitoring, and either died (52) or were discharged (88). The median (interquartile range) age was 61 years (48-74); 73% men; and ethnicity was White 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 with discharged patients, those who died had elevated peak troponin I levels (0.27 versus 0.02 ng/mL) and more primary end point events (17% versus 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 patients with COVID-19 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. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04358029.

Keywords: arrhythmias, cardiac; atrioventricular block; coronavirus; myocardial infarction; ventricular fibrillation.

Figures

Figure.
Figure.
Cardiac arrhythmias. COVID-19 indicates coronavirus disease 2019; and PCR, polymerase chain reaction.

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