Effects of SARS-CoV-2 infection on patients with a history of atrial fibrillation

Rapid transmission of coronavirus 2 (SARS-CoV-2) in severe acute respiratory syndrome caused a pandemic of coronavirus disease 2019 (COVID-19). SARS-CoV-2 is highly toxic, highly contagious, and is characterized by causing a wide range of infectious diseases, from mild to severe.

Since the outbreak of the pandemic, scientists have made great efforts to understand different aspects of the virus, its mode of transmission, underlying mechanisms, and how it affects individuals of different age groups and comorbidities. I have paid.

Background

Italy was one of the most affected countries during the first wave of SARS-CoV-2 infection, according to some reports. Scientists believe that atrial fibrillation (AF) can complicate the clinical outcome of COVID-19 disease, especially for inpatients. Atrial fibrillation is an irregular, very fast heart rhythm (arrhythmia) that can cause blood clots in the heart. AF patients are at increased risk of heart failure, stroke, and other heart complications.

Researchers say that existing AF may increase systemic inflammation and thus affect the clinical outcome of severely infected inpatients with COVID-19. In addition, AF reduces an individual’s ability to compensate for hemodynamic changes in acute SARS-CoV-2 disease. Scientists say there is very poor evidence of the prognosis of hospitalized COVID-19 patients with a history of atrial fibrillation.

Previous studies have shown a strong association between cardiovascular disease and COVID-19, but how different forms of AF affect the clinical outcome of COVID-19 disease. The data is very limited.

New research

To address the aforementioned research gap, scientists assessed whether AF could be considered a comorbidity. They also determined the type of existing AF that increased the risk of developing a severe form of SARS-CoV-2 infection or even death.This study is available at medicine..

In this study, scientists performed an observational retrospective analysis of COVID-19 patients admitted to nine Italian hospitals between March 1 and April 30, 2020. And its type (paroxysmal, persistent, or persistent). The cohort was divided into two groups based on the history of atrial fibrillation as a comorbidity. One group had no history of atrial fibrillation and the other group had a history of atrial fibrillation.

In addition, the group, including individuals with a history of atrial fibrillation, was subdivided based on type. That is, a history group of persistent atrial fibrillation and a history group of non-permanent atrial fibrillation. In this study, scientists diagnosed AF using 12-lead ECG (ECG) or continuous portable ECG monitoring.

Survey results

The current study found that 25% of patients hospitalized for COVID-19 infection had a history of atrial fibrillation. This result confirms that AF is a frequent comorbidity associated with SARS-CoV-2 infection. Previous studies have shown that a history of AF is strongly associated with acute respiratory distress syndrome (ARDS), but this study reveals that a history of AF does not affect in-hospital mortality. became. A previous study conducted in Northern Ireland reported that 75% of older patients hospitalized for COVID-19 had a history of atrial fibrillation. AF was present in 24.5% of 355 non-surviving COVID-19 patients, according to data provided by the COVID-19 Task Force of the Italian National Institute of Health. Recently, the New York State Department of Health reported that AF was the seventh comorbidity of COVID-19.

The authors of this study reported that AF affects the clinical outcome of patients with COVID-19 by increasing the likelihood of ARDS. They emphasized that AF should be considered in cardiovascular complications that cause a rapid exacerbation of respiratory illness. Previous studies have hypothesized that AF may be the underlying arrhythmia marker for inflammatory effects.

Differences between the results of current studies and previous studies on the risk of in-hospital mortality may be due to a diverse cohort of studies that make up the different prevalences of inpatients with AF.

The study concluded that the clinical outcomes of hospitalized COVID-19 patients were not affected by existing AF types (permanent or non-permanent).

The results of the current study are consistent with previous studies on the development of thromboembolism and pulmonary embolism.

Limitations

Two of the limitations of this study are its observational retrospective design and heterogeneity in the clinical manifestations of SARS-CoV-2 infection. In addition, due to the lack of computed tomography imaging data, researchers determined the severity of SARS-CoV-2 infection based on the presence of severe ARDS in the hospital. A further limitation of this study is the small sample size.

Conclusion

This study found that existing AF frequently co-exists in hospitalized COVID-19 patients. This is independent of ARDS, but not in-hospital mortality. The authors recommended careful clinical monitoring of COVID-19 inpatients with AF to detect patients at high risk of developing ARDS early.