Worldwide Survey of COVID-19-Associated Arrhythmias

Ellie J. Coromilas; Stephanie Kochav; Isaac Goldenthal; Angelo Biviano; Hasan Garan; Seth Goldbarg; Joon Hyuk Kim; Ilhwan Yeo; Cynthia Tracy; Shant Ayanian; Joseph Akar; Avinainder Singh; Shashank Jain; Leandro Zimerman; Maurício Pimentel; Stefan Osswald; Raphael Twerenbold; Nicolas Schaerli; Lia Crotti; Daniele Fabbri; Gianfranco Parati; Yi Li; Felipe Atienza; Eduardo Zatarain; Gary Tse; Keith Sai Kit Leung; Milton E. Guevara-Valdivia; Carlos A. Rivera-Santiago; Kyoko Soejima; Paolo De Filippo; Paola Ferrari; Giovanni Malanchini; Prapa Kanagaratnam; Saud Khawaja; Ghada W. Mikhail; Mauricio Scanavacca; Ludhmila Abrahão Hajjar; Brenno Rizerio; Luciana Sacilotto; Reza Mollazadeh; Masoud Eslami; Vahideh Laleh Far; Anna Vittoria Mattioli; Giuseppe Boriani; Federico Migliore; Alberto Cipriani; Filippo Donato; Paolo Compagnucci; Michela Casella; Antonio Dello Russo; James Coromilas; Andrew Aboyme; Connor Galen O'Brien; Fatima Rodriguez; Paul J. Wang; Aditi Naniwadekar; Melissa Moey; Chia Siang Kow; Wee Kooi Cheah; Angelo Auricchio; Giulio Conte; Jongmin Hwang; Seongwook Han; Pietro Enea Lazzerini; Federico Franchi; Amato Santoro; Pier Leopoldo Capecchi; Jose A. Joglar; Anna G. Rosenblatt; Marco Zardini; Serena Bricoli; Rosario Bonura; Julio Echarte-Morales; Tomás Benito-González; Carlos Minguito-Carazo; Felipe Fernández-Vázquez; Elaine Y. Wan

doi:10.1161/CIRCEP.120.009458

Worldwide Survey of COVID-19-Associated Arrhythmias

Ellie J. Coromilas, Stephanie Kochav, Isaac Goldenthal, Angelo Biviano, Hasan Garan, Seth Goldbarg, Joon Hyuk Kim, Ilhwan Yeo, Cynthia Tracy, Shant Ayanian, Joseph Akar, Avinainder Singh, Shashank Jain, Leandro Zimerman, Maurício Pimentel, Stefan Osswald, Raphael Twerenbold, Nicolas Schaerli, Lia Crotti, Daniele FabbriGianfranco Parati, Yi Li, Felipe Atienza, Eduardo Zatarain, Gary Tse, Keith Sai Kit Leung, Milton E. Guevara-Valdivia, Carlos A. Rivera-Santiago, Kyoko Soejima, Paolo De Filippo, Paola Ferrari, Giovanni Malanchini, Prapa Kanagaratnam, Saud Khawaja, Ghada W. Mikhail, Mauricio Scanavacca, Ludhmila Abrahão Hajjar, Brenno Rizerio, Luciana Sacilotto, Reza Mollazadeh, Masoud Eslami, Vahideh Laleh Far, Anna Vittoria Mattioli, Giuseppe Boriani, Federico Migliore, Alberto Cipriani, Filippo Donato, Paolo Compagnucci, Michela Casella, Antonio Dello Russo, James Coromilas, Andrew Aboyme, Connor Galen O'Brien, Fatima Rodriguez, Paul J. Wang, Aditi Naniwadekar, Melissa Moey, Chia Siang Kow, Wee Kooi Cheah, Angelo Auricchio, Giulio Conte, Jongmin Hwang, Seongwook Han, Pietro Enea Lazzerini, Federico Franchi, Amato Santoro, Pier Leopoldo Capecchi, Jose A. Joglar, Anna G. Rosenblatt, Marco Zardini, Serena Bricoli, Rosario Bonura, Julio Echarte-Morales, Tomás Benito-González, Carlos Minguito-Carazo, Felipe Fernández-Vázquez, Elaine Y. Wan

Research output: Contribution to journal › Article › peer-review

123 Scopus citations

Abstract

Background: Coronavirus disease 2019 (COVID-19) has led to over 1 million deaths worldwide and has been associated with cardiac complications including cardiac arrhythmias. The incidence and pathophysiology of these manifestations remain elusive. In this worldwide survey of patients hospitalized with COVID-19 who developed cardiac arrhythmias, we describe clinical characteristics associated with various arrhythmias, as well as global differences in modulations of routine electrophysiology practice during the pandemic. Methods: We conducted a retrospective analysis of patients hospitalized with COVID-19 infection worldwide with and without incident cardiac arrhythmias. Patients with documented atrial fibrillation, atrial flutter, supraventricular tachycardia, nonsustained or sustained ventricular tachycardia, ventricular fibrillation, atrioventricular block, or marked sinus bradycardia (heart rate<40 bpm) were classified as having arrhythmia. Deidentified data was provided by each institution and analyzed. Results: Data were collected for 4526 patients across 4 continents and 12 countries, 827 of whom had an arrhythmia. Cardiac comorbidities were common in patients with arrhythmia: 69% had hypertension, 42% diabetes, 30% had heart failure, and 24% had coronary artery disease. Most had no prior history of arrhythmia. Of those who did develop an arrhythmia, the majority (81.8%) developed atrial arrhythmias, 20.7% developed ventricular arrhythmias, and 22.6% had bradyarrhythmia. Regional differences suggested a lower incidence of atrial fibrillation in Asia compared with other continents (34% versus 63%). Most patients in North America and Europe received hydroxychloroquine, although the frequency of hydroxychloroquine therapy was constant across arrhythmia types. Forty-three percent of patients who developed arrhythmia were mechanically ventilated and 51% survived to hospital discharge. Many institutions reported drastic decreases in electrophysiology procedures performed. Conclusions: Cardiac arrhythmias are common and associated with high morbidity and mortality among patients hospitalized with COVID-19 infection. There were significant regional variations in the types of arrhythmias and treatment approaches.

Original language	English (US)
Pages (from-to)	E009458
Journal	Circulation: Arrhythmia and Electrophysiology
Volume	14
Issue number	3
DOIs	https://doi.org/10.1161/CIRCEP.120.009458
State	Published - Mar 1 2021

Keywords

COVID-19
arrhythmia
atrial fibrillation
atrial flutter
bradycardia
tachycardia
torsade de pointes

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Physiology (medical)

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10.1161/CIRCEP.120.009458

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Coromilas, E. J., Kochav, S., Goldenthal, I., Biviano, A., Garan, H., Goldbarg, S., Kim, J. H., Yeo, I., Tracy, C., Ayanian, S., Akar, J., Singh, A., Jain, S., Zimerman, L., Pimentel, M., Osswald, S., Twerenbold, R., Schaerli, N., Crotti, L., ... Wan, E. Y. (2021). Worldwide Survey of COVID-19-Associated Arrhythmias. Circulation: Arrhythmia and Electrophysiology, 14(3), E009458. https://doi.org/10.1161/CIRCEP.120.009458

Coromilas, EJ, Kochav, S, Goldenthal, I, Biviano, A, Garan, H, Goldbarg, S, Kim, JH, Yeo, I, Tracy, C, Ayanian, S, Akar, J, Singh, A, Jain, S, Zimerman, L, Pimentel, M, Osswald, S, Twerenbold, R, Schaerli, N, Crotti, L, Fabbri, D, Parati, G, Li, Y, Atienza, F, Zatarain, E, Tse, G, Leung, KSK, Guevara-Valdivia, ME, Rivera-Santiago, CA, Soejima, K, De Filippo, P, Ferrari, P, Malanchini, G, Kanagaratnam, P, Khawaja, S, Mikhail, GW, Scanavacca, M, Abrahão Hajjar, L, Rizerio, B, Sacilotto, L, Mollazadeh, R, Eslami, M, Laleh Far, V, Mattioli, AV, Boriani, G, Migliore, F, Cipriani, A, Donato, F, Compagnucci, P, Casella, M, Dello Russo, A, Coromilas, J, Aboyme, A, O'Brien, CG, Rodriguez, F, Wang, PJ, Naniwadekar, A, Moey, M, Kow, CS, Cheah, WK, Auricchio, A, Conte, G, Hwang, J, Han, S, Lazzerini, PE, Franchi, F, Santoro, A, Capecchi, PL, Joglar, JA, Rosenblatt, AG, Zardini, M, Bricoli, S, Bonura, R, Echarte-Morales, J, Benito-González, T, Minguito-Carazo, C, Fernández-Vázquez, F & Wan, EY 2021, 'Worldwide Survey of COVID-19-Associated Arrhythmias', Circulation: Arrhythmia and Electrophysiology, vol. 14, no. 3, pp. E009458. https://doi.org/10.1161/CIRCEP.120.009458

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title = "Worldwide Survey of COVID-19-Associated Arrhythmias",

abstract = "Background: Coronavirus disease 2019 (COVID-19) has led to over 1 million deaths worldwide and has been associated with cardiac complications including cardiac arrhythmias. The incidence and pathophysiology of these manifestations remain elusive. In this worldwide survey of patients hospitalized with COVID-19 who developed cardiac arrhythmias, we describe clinical characteristics associated with various arrhythmias, as well as global differences in modulations of routine electrophysiology practice during the pandemic. Methods: We conducted a retrospective analysis of patients hospitalized with COVID-19 infection worldwide with and without incident cardiac arrhythmias. Patients with documented atrial fibrillation, atrial flutter, supraventricular tachycardia, nonsustained or sustained ventricular tachycardia, ventricular fibrillation, atrioventricular block, or marked sinus bradycardia (heart rate<40 bpm) were classified as having arrhythmia. Deidentified data was provided by each institution and analyzed. Results: Data were collected for 4526 patients across 4 continents and 12 countries, 827 of whom had an arrhythmia. Cardiac comorbidities were common in patients with arrhythmia: 69% had hypertension, 42% diabetes, 30% had heart failure, and 24% had coronary artery disease. Most had no prior history of arrhythmia. Of those who did develop an arrhythmia, the majority (81.8%) developed atrial arrhythmias, 20.7% developed ventricular arrhythmias, and 22.6% had bradyarrhythmia. Regional differences suggested a lower incidence of atrial fibrillation in Asia compared with other continents (34% versus 63%). Most patients in North America and Europe received hydroxychloroquine, although the frequency of hydroxychloroquine therapy was constant across arrhythmia types. Forty-three percent of patients who developed arrhythmia were mechanically ventilated and 51% survived to hospital discharge. Many institutions reported drastic decreases in electrophysiology procedures performed. Conclusions: Cardiac arrhythmias are common and associated with high morbidity and mortality among patients hospitalized with COVID-19 infection. There were significant regional variations in the types of arrhythmias and treatment approaches.",

keywords = "COVID-19, arrhythmia, atrial fibrillation, atrial flutter, bradycardia, tachycardia, torsade de pointes",

author = "Coromilas, {Ellie J.} and Stephanie Kochav and Isaac Goldenthal and Angelo Biviano and Hasan Garan and Seth Goldbarg and Kim, {Joon Hyuk} and Ilhwan Yeo and Cynthia Tracy and Shant Ayanian and Joseph Akar and Avinainder Singh and Shashank Jain and Leandro Zimerman and Maur{\'i}cio Pimentel and Stefan Osswald and Raphael Twerenbold and Nicolas Schaerli and Lia Crotti and Daniele Fabbri and Gianfranco Parati and Yi Li and Felipe Atienza and Eduardo Zatarain and Gary Tse and Leung, {Keith Sai Kit} and Guevara-Valdivia, {Milton E.} and Rivera-Santiago, {Carlos A.} and Kyoko Soejima and {De Filippo}, Paolo and Paola Ferrari and Giovanni Malanchini and Prapa Kanagaratnam and Saud Khawaja and Mikhail, {Ghada W.} and Mauricio Scanavacca and {Abrah{\~a}o Hajjar}, Ludhmila and Brenno Rizerio and Luciana Sacilotto and Reza Mollazadeh and Masoud Eslami and {Laleh Far}, Vahideh and Mattioli, {Anna Vittoria} and Giuseppe Boriani and Federico Migliore and Alberto Cipriani and Filippo Donato and Paolo Compagnucci and Michela Casella and {Dello Russo}, Antonio and James Coromilas and Andrew Aboyme and O'Brien, {Connor Galen} and Fatima Rodriguez and Wang, {Paul J.} and Aditi Naniwadekar and Melissa Moey and Kow, {Chia Siang} and Cheah, {Wee Kooi} and Angelo Auricchio and Giulio Conte and Jongmin Hwang and Seongwook Han and Lazzerini, {Pietro Enea} and Federico Franchi and Amato Santoro and Capecchi, {Pier Leopoldo} and Joglar, {Jose A.} and Rosenblatt, {Anna G.} and Marco Zardini and Serena Bricoli and Rosario Bonura and Julio Echarte-Morales and Tom{\'a}s Benito-Gonz{\'a}lez and Carlos Minguito-Carazo and Felipe Fern{\'a}ndez-V{\'a}zquez and Wan, {Elaine Y.}",

note = "Publisher Copyright: {\textcopyright} 2021 American Heart Association, Inc.",

year = "2021",

month = mar,

day = "1",

doi = "10.1161/CIRCEP.120.009458",

language = "English (US)",

volume = "14",

pages = "E009458",

journal = "Circulation: Arrhythmia and Electrophysiology",

issn = "1941-3149",

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TY - JOUR

T1 - Worldwide Survey of COVID-19-Associated Arrhythmias

AU - Coromilas, Ellie J.

AU - Kochav, Stephanie

AU - Goldenthal, Isaac

AU - Biviano, Angelo

AU - Garan, Hasan

AU - Goldbarg, Seth

AU - Kim, Joon Hyuk

AU - Yeo, Ilhwan

AU - Tracy, Cynthia

AU - Ayanian, Shant

AU - Akar, Joseph

AU - Singh, Avinainder

AU - Jain, Shashank

AU - Zimerman, Leandro

AU - Pimentel, Maurício

AU - Osswald, Stefan

AU - Twerenbold, Raphael

AU - Schaerli, Nicolas

AU - Crotti, Lia

AU - Fabbri, Daniele

AU - Parati, Gianfranco

AU - Li, Yi

AU - Atienza, Felipe

AU - Zatarain, Eduardo

AU - Tse, Gary

AU - Leung, Keith Sai Kit

AU - Guevara-Valdivia, Milton E.

AU - Rivera-Santiago, Carlos A.

AU - Soejima, Kyoko

AU - De Filippo, Paolo

AU - Ferrari, Paola

AU - Malanchini, Giovanni

AU - Kanagaratnam, Prapa

AU - Khawaja, Saud

AU - Mikhail, Ghada W.

AU - Scanavacca, Mauricio

AU - Abrahão Hajjar, Ludhmila

AU - Rizerio, Brenno

AU - Sacilotto, Luciana

AU - Mollazadeh, Reza

AU - Eslami, Masoud

AU - Laleh Far, Vahideh

AU - Mattioli, Anna Vittoria

AU - Boriani, Giuseppe

AU - Migliore, Federico

AU - Cipriani, Alberto

AU - Donato, Filippo

AU - Compagnucci, Paolo

AU - Casella, Michela

AU - Dello Russo, Antonio

AU - Coromilas, James

AU - Aboyme, Andrew

AU - O'Brien, Connor Galen

AU - Rodriguez, Fatima

AU - Wang, Paul J.

AU - Naniwadekar, Aditi

AU - Moey, Melissa

AU - Kow, Chia Siang

AU - Cheah, Wee Kooi

AU - Auricchio, Angelo

AU - Conte, Giulio

AU - Hwang, Jongmin

AU - Han, Seongwook

AU - Lazzerini, Pietro Enea

AU - Franchi, Federico

AU - Santoro, Amato

AU - Capecchi, Pier Leopoldo

AU - Joglar, Jose A.

AU - Rosenblatt, Anna G.

AU - Zardini, Marco

AU - Bricoli, Serena

AU - Bonura, Rosario

AU - Echarte-Morales, Julio

AU - Benito-González, Tomás

AU - Minguito-Carazo, Carlos

AU - Fernández-Vázquez, Felipe

AU - Wan, Elaine Y.

PY - 2021/3/1

Y1 - 2021/3/1

N2 - Background: Coronavirus disease 2019 (COVID-19) has led to over 1 million deaths worldwide and has been associated with cardiac complications including cardiac arrhythmias. The incidence and pathophysiology of these manifestations remain elusive. In this worldwide survey of patients hospitalized with COVID-19 who developed cardiac arrhythmias, we describe clinical characteristics associated with various arrhythmias, as well as global differences in modulations of routine electrophysiology practice during the pandemic. Methods: We conducted a retrospective analysis of patients hospitalized with COVID-19 infection worldwide with and without incident cardiac arrhythmias. Patients with documented atrial fibrillation, atrial flutter, supraventricular tachycardia, nonsustained or sustained ventricular tachycardia, ventricular fibrillation, atrioventricular block, or marked sinus bradycardia (heart rate<40 bpm) were classified as having arrhythmia. Deidentified data was provided by each institution and analyzed. Results: Data were collected for 4526 patients across 4 continents and 12 countries, 827 of whom had an arrhythmia. Cardiac comorbidities were common in patients with arrhythmia: 69% had hypertension, 42% diabetes, 30% had heart failure, and 24% had coronary artery disease. Most had no prior history of arrhythmia. Of those who did develop an arrhythmia, the majority (81.8%) developed atrial arrhythmias, 20.7% developed ventricular arrhythmias, and 22.6% had bradyarrhythmia. Regional differences suggested a lower incidence of atrial fibrillation in Asia compared with other continents (34% versus 63%). Most patients in North America and Europe received hydroxychloroquine, although the frequency of hydroxychloroquine therapy was constant across arrhythmia types. Forty-three percent of patients who developed arrhythmia were mechanically ventilated and 51% survived to hospital discharge. Many institutions reported drastic decreases in electrophysiology procedures performed. Conclusions: Cardiac arrhythmias are common and associated with high morbidity and mortality among patients hospitalized with COVID-19 infection. There were significant regional variations in the types of arrhythmias and treatment approaches.

AB - Background: Coronavirus disease 2019 (COVID-19) has led to over 1 million deaths worldwide and has been associated with cardiac complications including cardiac arrhythmias. The incidence and pathophysiology of these manifestations remain elusive. In this worldwide survey of patients hospitalized with COVID-19 who developed cardiac arrhythmias, we describe clinical characteristics associated with various arrhythmias, as well as global differences in modulations of routine electrophysiology practice during the pandemic. Methods: We conducted a retrospective analysis of patients hospitalized with COVID-19 infection worldwide with and without incident cardiac arrhythmias. Patients with documented atrial fibrillation, atrial flutter, supraventricular tachycardia, nonsustained or sustained ventricular tachycardia, ventricular fibrillation, atrioventricular block, or marked sinus bradycardia (heart rate<40 bpm) were classified as having arrhythmia. Deidentified data was provided by each institution and analyzed. Results: Data were collected for 4526 patients across 4 continents and 12 countries, 827 of whom had an arrhythmia. Cardiac comorbidities were common in patients with arrhythmia: 69% had hypertension, 42% diabetes, 30% had heart failure, and 24% had coronary artery disease. Most had no prior history of arrhythmia. Of those who did develop an arrhythmia, the majority (81.8%) developed atrial arrhythmias, 20.7% developed ventricular arrhythmias, and 22.6% had bradyarrhythmia. Regional differences suggested a lower incidence of atrial fibrillation in Asia compared with other continents (34% versus 63%). Most patients in North America and Europe received hydroxychloroquine, although the frequency of hydroxychloroquine therapy was constant across arrhythmia types. Forty-three percent of patients who developed arrhythmia were mechanically ventilated and 51% survived to hospital discharge. Many institutions reported drastic decreases in electrophysiology procedures performed. Conclusions: Cardiac arrhythmias are common and associated with high morbidity and mortality among patients hospitalized with COVID-19 infection. There were significant regional variations in the types of arrhythmias and treatment approaches.

KW - COVID-19

KW - arrhythmia

KW - atrial fibrillation

KW - atrial flutter

KW - bradycardia

KW - tachycardia

KW - torsade de pointes

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JO - Circulation: Arrhythmia and Electrophysiology

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ER -

Worldwide Survey of COVID-19-Associated Arrhythmias

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