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Ingul CB, Grimsmo J, Mecinaj A, Trebinjac D, Berger Nossen M, Andrup S, Stavem K, Josefsen T, Omland T, Jensen T. Cardiac arrhythmias 3 months after hospitalization for COVID-19. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
The long-term frequencies of cardiac arrhythmias in hospitalized coronavirus disease 2019 (COVID-19) patients have not been thoroughly investigated.
Purpose
To describe the prevalence of cardiac arrhythmias, 3–4 months after hospitalization for COVID-19.
Methods and results
Participants with COVID-19 discharged from five large Norwegian hospitals were invited to participate in a prospective cohort study. We examined 201 participants (44% females, mean age 58.5 years) with 24-hour electrocardiogram 3–4 months after discharge. Body mass index (BMI) was 28.3±4.5 kg/m2 (mean ± SD), and obesity (BMI >30) was found in 70 participants (34%). Clinically significant arrhythmias were defined as; ventricular tachycardia (non-sustained or sustained), premature ventricular contractions (PVC) exceeding 200/24 h, or coupled PVC, atrial fibrillation/flutter, second-degree atrioventricular block (AV-block) type 2, complete AV-block, sinoatrial (SA) block exceeding 3 s, premature AV-nodal beats in bigeminy, supraventricular tachycardia (SVT) exceeding 30 s, and sinus bradycardia with less than 30 beats/min. High-sensitive cardiac troponin T (hs-cTnT) was measured at the 3-month follow-up.
Results
Cardiac arrhythmias were found in 27% (n=54) of the participants. Ventricular premature contractions and non-sustained ventricular tachycardia were the most common arrhythmias, found in 22% (n=44) of the participants. Premature ventricular contractions were the most frequent cardiac arrhythmia. More than 200 PVCs per day were observed in 37 participants (18%) with a mean of 1300 PVC/day, and in 35 (95%) of these participants, the PVCs were polymorphic.
Among 10 patients experiencing NSVT, 5 participants had previous CVD, including coronary heart disease (n=1), 1 atrial fibrillation, 2 venous thromboembolism, 4 heart failure. Atrial fibrillation was found in seven patients (3%), none of them of new-onset.
SA block >3 seconds was only observed in one patient, and no incidence of high degree AV block was discovered. Pre-existing cardiovascular disease or hypertension (CVDH) were reported in 40% (n=81) of the participants. The CVDH group had an increased amount of arrhythmia compared to the group free of CVDH (p=0.04). High PVCs showed a fair correlation with hs-cTnT levels at 3 months (ρ=0.21 p=0.048).
Conclusions
Three months following hospital discharge with COVID-19, cardiac arrhythmia was found in every fourth participant and was associated with a higher concentration of hs-cTnT at 3 months. The clinical implications of persistent ventricular arrhythmia following COVID-19 is not clear, but ventricular ectopy has been linked to increased risk of cardiac disease, including cardiomyopathy and sudden cardiac death.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): The National Association for Heart, Lung diseases and the Norwegian Health Association and Akershus University Hospital.
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Affiliation(s)
- C B Ingul
- Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Trondheim, Norway
| | - J Grimsmo
- LHL Hospital Gardermoen, Oslo, Norway
| | - A Mecinaj
- Akershus University Hospital, Department of Cardiology, Division of Medicine, Oslo, Norway
| | | | - M Berger Nossen
- Østfold Hospital Trust Kalnes, Department of Cardiology, Grålum, Norway
| | - S Andrup
- Østfold Hospital Trust Kalnes, Department of Cardiology, Grålum, Norway
| | - K Stavem
- Akershus University Hospital, Pulmonary Department, Oslo, Norway
| | - T Josefsen
- Østfold Hospital Trust Kalnes, Department of Cardiology, Grålum, Norway
| | - T Omland
- Akershus University Hospital, Department of Cardiology, Division of Medicine, Oslo, Norway
| | - T Jensen
- Oslo University Hospital Ulleval, Oslo, Norway
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