Co-Author(s):
Mohit Turagam, MD
Samantha Sartori, PhD
Edward Chu, MD
Iwanari Kawamura, MD
Poojita Shivamurthy, MD
Mahmoud Bokhari, MD
Connor oates, MD
Chi Zhang, MD
Christopher Pumill, MD
Waqas Malick, MD
Helen Hashemi, MD
Tania Ruiz-maya, MD
Michael Hadley, MD
Jonathan Gandhi, MD
Dylan Sperling, MD
William Whang, MD
Jacob Koruth, MD
Marie-noelle Langan, MD
Aamir Sofi, MD
Anthony Gomes, MD
Stephanie harcum, MS
Sam Cammack, MS
Betsy Ellsworth, MSN
Srinivas Dukkipati, MD
Martin Goldman, MD
Jonathan Halperin, MD
Valentin Fuster, MD, PhD
Vivek Reddy, MD
Icahn School of Medicine at Mount Sinai
One Gustav Levy Place
Introduction | Objectives: Coronavirus Disease 2019 (COVID-19) results in increased levels of inflammatory markers previously associated with atrial arrhythmias. However, little is known about the incidence or specificity of these arrhythmias in COVID-19 or their association with outcomes. The purpose of this paper is to determine the incidence, predictors and outcomes of atrial fibrillation and flutter (AF/AFL) in patients hospitalized with COVID-19 compared to those hospitalized with the Influenza virus.
Methods: This is a retrospective analysis involving consecutive patients from five hospitals during the height of the COVID-19 pandemic in New York City. The primary analysis involved 3,970 patients admitted with PCR-positive COVID-19 between 2/4/2020-4/22/2020 with manual review performed of 1,110 these patients. The comparator arm included 1,420 patients with influenza hospitalized between 1/1/2017-1/1/2020 such that no temporal overlap occurred between groups.
Results: Among 3970 inpatients with COVID-19, the incidence of AF/AFL was 10% (N=375) and in patients without  a history of atrial arrhythmias, 4% (N=146).  Patients with new-onset AF/AFL were older and had higher levels of inflammatory markers including C-reactive protein (232 vs 175 mg/L, P< 0.0001) and Interleukin-6 (93 vs 68 pg/ml, P=0.001), and more myocardial injury (Troponin-I: 0.2 vs 0.06ng/ml, P< 0.0001).  AF/AFL were associated with increased mortality (46% vs 26%, P< 0.0001) and ischemic stroke (1.6% vs 0.6%, P=0.05).  Manual review captured a somewhat higher prevalence of AF/AFL (13%, N=140) compared to automated abstraction.  Compared to inpatients with COVID-19, patients with Influenza (N=1420) had similar rates of AF/AFL (12%, n=163) but lower overall mortality. The presence of AF/AFL during hospitalization correlated with similarly increased mortality in both COVID-19 (RR 1.77) and Influenza (RR 1.78).
Conclusions: AF/AFL occurred in a subset of patients hospitalized with COVID-19, and was associated with elevated markers of inflammation and disease severity as well as adverse outcomes.  The incidence and associated increase in mortality of AF/AFL in COVID-19 was similar to that observed with Influenza.
AFS 2021-07