Frontiers in Cardiovascular Medicine (Sep 2022)

COVID-19 and arrhythmia: The factors associated and the role of myocardial electrical impulse propagation. An observational study based on cardiac telemetric monitoring

  • Domenico Cozzolino,
  • Ciro Romano,
  • Riccardo Nevola,
  • Aldo Marrone,
  • Giuseppina R. Umano,
  • Giovanna Cuomo,
  • Luca Rinaldi,
  • Luigi E. Adinolfi,
  • Vanvitelli COVID Collaborators,
  • Abitabile Marianna,
  • Beccia Domenico,
  • Brin Chiara,
  • Carusone Caterina,
  • Cinone Francesca,
  • Colantuoni Sara,
  • Del Core Micol,
  • Gjeloshi Klodian,
  • Imbriani Simona,
  • Macaro Domenico,
  • Medicamento Giulia,
  • Meo Luciana,
  • Nappo Francesco,
  • Padula Andrea,
  • Ranieri Roberta,
  • Ricozzi Carmen,
  • Ruosi Carolina,
  • Sellitto Ausilia,
  • Sommese Pino,
  • Villani Angela,
  • Christian Catalini

DOI
https://doi.org/10.3389/fcvm.2022.912474
Journal volume & issue
Vol. 9

Abstract

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BackgroundThe heart is commonly involved in COVID-19, and rhythm disorders have been largely reported.ObjectiveTo evaluate the association of some non-cardiac and cardiac comorbidities and QT dispersion with arrhythmias and their impact on outcomes in hospitalized patients with COVID-19.MethodsEach patient underwent cardiac telemetry monitoring through the entire hospitalization period, laboratory analyses, 12-lead ECG, and lung imaging examination. Patients with arrhythmia were divided into three groups (bradyarrhythmias, tachyarrhythmias, and tachy- and bradyarrhythmias).ResultsTwo-hundred patients completed the study (males, 123; mean age, 70.1 years); of these, 80 patients (40%) exhibited rhythm disorders on telemetry. Patients with arrhythmia were older (p < 0.0001), had a greater number of comorbidities (p < 0.0001), higher values of creatinine (p = 0.007), B-type natriuretic peptide (p < 0.0001), troponin (p < 0.0001), C-reactive protein (p = 0.01), ferritin (p = 0.001), D-dimer (p < 0.0001), procalcitonin (p = 0.0008), QT interval (p = 0.002), QTc interval (p = 0.04), and QTc dispersion (p = 0.01), and lower values of sodium (p = 0.03), magnesium (p = 0.04), glomerular filtration rate (p < 0.0001), and hemoglobin (p = 0.008) as compared to patients without arrhythmia. By comparing the three subgroups of patients, no significant differences were found. At multivariate analysis, age [odds ratio (OR) = 1.14 (95% CI: 1.07–1.22); p = 0.0004], coronary artery disease [OR = 12.7 (95% CI: 2.38–68.01); p = 0.005], and circulating troponin [OR = 1.05 (95% CI: 1.003–1.10); p = 0.04] represented risk factors independently associated with arrhythmia. All-cause in-hospital mortality was ∼40-fold higher among patients with arrhythmia [OR = 39.66 (95% CI: 5.20–302.51); p = 0.0004].ConclusionArrhythmias are associated with aging, coronary artery disease, subtle myocardial injury, hyperinflammatory status, coagulative unbalance, and prolonged QTc dispersion in patients with COVID-19, and confer a worse in-hospital prognosis. Given its usefulness, routinary use of cardiac telemetry should be encouraged in COVID wards.

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