Severe COVID-19 Infection Linked to Greater Risk of Developing Arrhythmia

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Individuals with severe COVID-19 infection requiring mechanical ventilation were found to be 16 times more likely to develop ventricular tachycardia within 6 months, compared to peers without severe infections, according to new findings.¹

The research into the risk of arrhythmia after COVID-19 infection, presented in a late-breaking science session at the European Heart Rhythm Association (EHRA) 2022 scientific congress, suggests other heart rhythm disorders were additionally elevated in those with severe COVID-19.

“The actual likelihood of developing ventricular tachycardia or other arrhythmias after severe COVID-19 is low for the individual patient, but much higher than in those without severe infection,” said March Stahlberg, study author, Korlinska Institute in Stockholm, Sweden.¹

Stahlberg and colleagues investigated the long-term risk of arrhythmias after discharge from an intensive care unit (ICU) for patients with COVID-19 requiring mechanical ventilation. Using an ICU registry in Sweden, the team identified all patients with COVID-19 treated with mechanical ventilation and discharged alive from an ICU between March 2020 – June 2021. The analysis matched patients by age, sex, and district of residence with up to 10 in the general population.

Investigators used multiple compulsory national registries to record new diagnoses of arrhythmias after discharge from the ICU. A total of 3,023 patients with severe COVID-19 who received mechanical ventilation at an ICU in Sweden and 28,462 individuals from the general population who had not been in an ICU with COVID-19 requiring mechanical ventilation were included in the study. Participants had an average age of 62 years, and 30% were women.

“Higher age and male sex are two important risk factors for getting severely sick with COVID-19 and this was reflected in our study participants,” Stahlberg said.¹

The team denoted the primary outcomes as hospitalization with ventricular tachycardia, atrial fibrillation, other tachyarrhythmias, or bradycardia/pacemaker implantation.They analyzed the risk of developing each arrhythmia in patients with severe COVID-19, compared to those without severe COVID-19. Analyses were adjusted for risk factors associated with the likelihood of heart rhythm disorders, including age, sex, high blood pressure, diabetes, high blood lipids, chronic kidney disease, and socioeconomic status, including education level, marital status, and income.

At an average follow-up of nine months, the analysis showed the incidence rates per 1,000 person-years in patients who had severe COVID-19 were 15.4 for ventricular tachycardia, 78.4 for atrial fibrillation, 99.2 for other tachyarrhythmias, and 8.5 for bradycardia/pacemaker implantation. The corresponding incidence rates per 1,000 person-years in the control group were 0.9 for ventricular tachycardia, 6.0 for atrial fibrillation, 6.7 for other tachyarrhythmias, and 0.9 for bradycardia/pacemaker implantation.

Additionally, compared to the control group, patients with severe COVID-19 and required mechanical ventilation had a 16-fold risk of ventricular, 13-fold risk of atrial fibrillation, 14-fold risk of other tachyarrhythmias, and a 9-fold risk of bradycardia/pacemaker implantation, according to the analysis.

Stahlberg suggests that the addition of a heart rhythm disorder in patients with COVID-19 who require mechanical ventilation may worsen health and urges these individuals to seek medical attention if they develop palpitations or irregular heartbeat after hospital discharges. He noted that previous data has also indicated an increased risk of arrhythmias following COVID-19 infection in the bulk of those not requiring ICU treatment.

“Together, with our new data and taking into account that we globally have 650 million reported COVID-19 cases, hospital systems should prepare for an increase in patients requiring management for new-onset arrhythmias,” Stahlberg said.¹

References

1. Escardio. (2023, April 18). Severe covid-19 linked with 16-fold risk of life-threatening heart rhythm within 6 months. EurekAlert! Retrieved April 20, 2023, from https://www.eurekalert.org/news-releases/986232