Atrial arrhythmia related outcomes in critically ill COVID‐19 patients
Rationale Coronavirus disease 2019 (COVID‐19) is associated with many clinical manifestations including respiratory failure and cardiovascular compromise. Objectives We examine outcomes in critically ill individuals with COVID‐19 who develop atrial tachyarrhythmias. Methods We collected data from el...
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| Veröffentlicht in: | Pacing and clinical electrophysiology 2021-05, Vol.44 (5), p.814-823 |
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| creator | Colon, Chad M. Barrios, James G. Chiles, Joe W. Brown, Todd M. Pogwizd, Steven M. McElwee, Samuel K. Gandotra, Sheetal Russell, Derek W. McElderry, H. Tom Maddox, William R. |
| description | Rationale
Coronavirus disease 2019 (COVID‐19) is associated with many clinical manifestations including respiratory failure and cardiovascular compromise.
Objectives
We examine outcomes in critically ill individuals with COVID‐19 who develop atrial tachyarrhythmias.
Methods
We collected data from electrocardiograms and the electronic medical record of COVID‐19 positive (COVID+) and negative (COVID−) individuals admitted to our medical intensive care unit between February 29 and June 28, 2020. We compared clinical and demographic characteristics, new onset atrial tachyarrhythmia, hemodynamic compromise following atrial tachyarrhythmia, and in‐hospital mortality in COVID+ versus COVID−. Hemodynamic compromise was defined as having a new or increased vasopressor requirement or the need for direct current cardioversion for hemodynamic instability within 1 hour of atrial tachyarrhythmia onset.
Results
Of 300 individuals included, 200 were COVID+ and 100 were COVID−. Mean age was 60 ± 16 years, 180 (60%) were males, and 170 (57%) were African American. New onset atrial tachyarrhythmia occurred in 16% of COVID+ and 19% of COVID− individuals (P = .51). When compared to COVID− participants without atrial tachyarrhythmia, COVID+ individuals with new onset atrial tachyarrhythmia had higher mortality after multivariable adjustment (OR 5.0, 95% CI 1.9–13.5). New onset atrial tachyarrhythmia was followed by hemodynamic compromise in 18 COVID+ but no COVID− participants (P = .0001). COVID+ individuals with hemodynamic compromise after atrial tachyarrhythmia required increased ventilatory support at the time of atrial tachyarrhythmia onset.
Conclusions
Atrial tachyarrhythmia is associated with increased mortality in critically ill individuals with COVID‐19, especially those mechanically ventilated. Recognition of this could assist with clinical care for individuals with COVID‐19. |
| doi_str_mv | 10.1111/pace.14221 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8250783</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2503434809</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4481-592d118eeefe9361550ce051802e5b3fe5bf87c14b17778fc212ef5e3a2ef4a93</originalsourceid><addsrcrecordid>eNp9kc1OGzEQxy3UClLgwgNUK_WCkBY8_oi9l0pRypeEBAfgajnObGPk3U3tXVBufQSesU-CQyhqe-gcZg7-6Tdj_Qk5AHoMuU6W1uExCMZgi4xAClpqkNUHMqIgVKm5rnbIp5QeKKVjKuQ22eFcca2BjcjFpI_ehsLGuFj1i8bbImKwPc6Lbuhd12AqfFu46HvvbAirwodQTK_vL7_9-vkMVbG0vce2T3vkY21Dwv23uUvuzk5vpxfl1fX55XRyVTohNJSyYnMAjYg1VnwMUlKHVIKmDOWM17nVWjkQM1BK6doxYFhL5DYPYSu-S75uvMth1uDc5d3RBrOMvrFxZTrrzd8vrV-Y792j0UxSpXkWHL4JYvdjwNSbxieHIdgWuyGZjHHBhabrXV_-QR-6Ibb5e5liHKqxqlSmjjaUi11KEev3Y4CadUBmHZB5DSjDn_88_x39nUgGYAM8-YCr_6jMzWR6upG-AOTcm7Q</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2523196797</pqid></control><display><type>article</type><title>Atrial arrhythmia related outcomes in critically ill COVID‐19 patients</title><source>Wiley Online Library Journals Frontfile Complete</source><creator>Colon, Chad M. ; Barrios, James G. ; Chiles, Joe W. ; Brown, Todd M. ; Pogwizd, Steven M. ; McElwee, Samuel K. ; Gandotra, Sheetal ; Russell, Derek W. ; McElderry, H. Tom ; Maddox, William R.</creator><creatorcontrib>Colon, Chad M. ; Barrios, James G. ; Chiles, Joe W. ; Brown, Todd M. ; Pogwizd, Steven M. ; McElwee, Samuel K. ; Gandotra, Sheetal ; Russell, Derek W. ; McElderry, H. Tom ; Maddox, William R.</creatorcontrib><description>Rationale
Coronavirus disease 2019 (COVID‐19) is associated with many clinical manifestations including respiratory failure and cardiovascular compromise.
Objectives
We examine outcomes in critically ill individuals with COVID‐19 who develop atrial tachyarrhythmias.
Methods
We collected data from electrocardiograms and the electronic medical record of COVID‐19 positive (COVID+) and negative (COVID−) individuals admitted to our medical intensive care unit between February 29 and June 28, 2020. We compared clinical and demographic characteristics, new onset atrial tachyarrhythmia, hemodynamic compromise following atrial tachyarrhythmia, and in‐hospital mortality in COVID+ versus COVID−. Hemodynamic compromise was defined as having a new or increased vasopressor requirement or the need for direct current cardioversion for hemodynamic instability within 1 hour of atrial tachyarrhythmia onset.
Results
Of 300 individuals included, 200 were COVID+ and 100 were COVID−. Mean age was 60 ± 16 years, 180 (60%) were males, and 170 (57%) were African American. New onset atrial tachyarrhythmia occurred in 16% of COVID+ and 19% of COVID− individuals (P = .51). When compared to COVID− participants without atrial tachyarrhythmia, COVID+ individuals with new onset atrial tachyarrhythmia had higher mortality after multivariable adjustment (OR 5.0, 95% CI 1.9–13.5). New onset atrial tachyarrhythmia was followed by hemodynamic compromise in 18 COVID+ but no COVID− participants (P = .0001). COVID+ individuals with hemodynamic compromise after atrial tachyarrhythmia required increased ventilatory support at the time of atrial tachyarrhythmia onset.
Conclusions
Atrial tachyarrhythmia is associated with increased mortality in critically ill individuals with COVID‐19, especially those mechanically ventilated. Recognition of this could assist with clinical care for individuals with COVID‐19.</description><identifier>ISSN: 0147-8389</identifier><identifier>EISSN: 1540-8159</identifier><identifier>DOI: 10.1111/pace.14221</identifier><identifier>PMID: 33738812</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Arrhythmia ; atrial arrhythmias ; atrial fibrillation ; atrial flutter ; atrial tachycardia ; Cardiac arrhythmia ; Coronaviruses ; COVID-19 ; Electronic medical records ; Electrophysiology ; Mortality ; Tachyarrhythmia</subject><ispartof>Pacing and clinical electrophysiology, 2021-05, Vol.44 (5), p.814-823</ispartof><rights>2021 Wiley Periodicals LLC</rights><rights>2021 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4481-592d118eeefe9361550ce051802e5b3fe5bf87c14b17778fc212ef5e3a2ef4a93</citedby><cites>FETCH-LOGICAL-c4481-592d118eeefe9361550ce051802e5b3fe5bf87c14b17778fc212ef5e3a2ef4a93</cites><orcidid>0000-0003-3504-0451</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fpace.14221$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fpace.14221$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,780,784,885,1416,27915,27916,45565,45566</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33738812$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Colon, Chad M.</creatorcontrib><creatorcontrib>Barrios, James G.</creatorcontrib><creatorcontrib>Chiles, Joe W.</creatorcontrib><creatorcontrib>Brown, Todd M.</creatorcontrib><creatorcontrib>Pogwizd, Steven M.</creatorcontrib><creatorcontrib>McElwee, Samuel K.</creatorcontrib><creatorcontrib>Gandotra, Sheetal</creatorcontrib><creatorcontrib>Russell, Derek W.</creatorcontrib><creatorcontrib>McElderry, H. Tom</creatorcontrib><creatorcontrib>Maddox, William R.</creatorcontrib><title>Atrial arrhythmia related outcomes in critically ill COVID‐19 patients</title><title>Pacing and clinical electrophysiology</title><addtitle>Pacing Clin Electrophysiol</addtitle><description>Rationale
Coronavirus disease 2019 (COVID‐19) is associated with many clinical manifestations including respiratory failure and cardiovascular compromise.
Objectives
We examine outcomes in critically ill individuals with COVID‐19 who develop atrial tachyarrhythmias.
Methods
We collected data from electrocardiograms and the electronic medical record of COVID‐19 positive (COVID+) and negative (COVID−) individuals admitted to our medical intensive care unit between February 29 and June 28, 2020. We compared clinical and demographic characteristics, new onset atrial tachyarrhythmia, hemodynamic compromise following atrial tachyarrhythmia, and in‐hospital mortality in COVID+ versus COVID−. Hemodynamic compromise was defined as having a new or increased vasopressor requirement or the need for direct current cardioversion for hemodynamic instability within 1 hour of atrial tachyarrhythmia onset.
Results
Of 300 individuals included, 200 were COVID+ and 100 were COVID−. Mean age was 60 ± 16 years, 180 (60%) were males, and 170 (57%) were African American. New onset atrial tachyarrhythmia occurred in 16% of COVID+ and 19% of COVID− individuals (P = .51). When compared to COVID− participants without atrial tachyarrhythmia, COVID+ individuals with new onset atrial tachyarrhythmia had higher mortality after multivariable adjustment (OR 5.0, 95% CI 1.9–13.5). New onset atrial tachyarrhythmia was followed by hemodynamic compromise in 18 COVID+ but no COVID− participants (P = .0001). COVID+ individuals with hemodynamic compromise after atrial tachyarrhythmia required increased ventilatory support at the time of atrial tachyarrhythmia onset.
Conclusions
Atrial tachyarrhythmia is associated with increased mortality in critically ill individuals with COVID‐19, especially those mechanically ventilated. Recognition of this could assist with clinical care for individuals with COVID‐19.</description><subject>Arrhythmia</subject><subject>atrial arrhythmias</subject><subject>atrial fibrillation</subject><subject>atrial flutter</subject><subject>atrial tachycardia</subject><subject>Cardiac arrhythmia</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>Electronic medical records</subject><subject>Electrophysiology</subject><subject>Mortality</subject><subject>Tachyarrhythmia</subject><issn>0147-8389</issn><issn>1540-8159</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kc1OGzEQxy3UClLgwgNUK_WCkBY8_oi9l0pRypeEBAfgajnObGPk3U3tXVBufQSesU-CQyhqe-gcZg7-6Tdj_Qk5AHoMuU6W1uExCMZgi4xAClpqkNUHMqIgVKm5rnbIp5QeKKVjKuQ22eFcca2BjcjFpI_ehsLGuFj1i8bbImKwPc6Lbuhd12AqfFu46HvvbAirwodQTK_vL7_9-vkMVbG0vce2T3vkY21Dwv23uUvuzk5vpxfl1fX55XRyVTohNJSyYnMAjYg1VnwMUlKHVIKmDOWM17nVWjkQM1BK6doxYFhL5DYPYSu-S75uvMth1uDc5d3RBrOMvrFxZTrrzd8vrV-Y792j0UxSpXkWHL4JYvdjwNSbxieHIdgWuyGZjHHBhabrXV_-QR-6Ibb5e5liHKqxqlSmjjaUi11KEev3Y4CadUBmHZB5DSjDn_88_x39nUgGYAM8-YCr_6jMzWR6upG-AOTcm7Q</recordid><startdate>202105</startdate><enddate>202105</enddate><creator>Colon, Chad M.</creator><creator>Barrios, James G.</creator><creator>Chiles, Joe W.</creator><creator>Brown, Todd M.</creator><creator>Pogwizd, Steven M.</creator><creator>McElwee, Samuel K.</creator><creator>Gandotra, Sheetal</creator><creator>Russell, Derek W.</creator><creator>McElderry, H. Tom</creator><creator>Maddox, William R.</creator><general>Wiley Subscription Services, Inc</general><general>John Wiley and Sons Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-3504-0451</orcidid></search><sort><creationdate>202105</creationdate><title>Atrial arrhythmia related outcomes in critically ill COVID‐19 patients</title><author>Colon, Chad M. ; Barrios, James G. ; Chiles, Joe W. ; Brown, Todd M. ; Pogwizd, Steven M. ; McElwee, Samuel K. ; Gandotra, Sheetal ; Russell, Derek W. ; McElderry, H. Tom ; Maddox, William R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4481-592d118eeefe9361550ce051802e5b3fe5bf87c14b17778fc212ef5e3a2ef4a93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Arrhythmia</topic><topic>atrial arrhythmias</topic><topic>atrial fibrillation</topic><topic>atrial flutter</topic><topic>atrial tachycardia</topic><topic>Cardiac arrhythmia</topic><topic>Coronaviruses</topic><topic>COVID-19</topic><topic>Electronic medical records</topic><topic>Electrophysiology</topic><topic>Mortality</topic><topic>Tachyarrhythmia</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Colon, Chad M.</creatorcontrib><creatorcontrib>Barrios, James G.</creatorcontrib><creatorcontrib>Chiles, Joe W.</creatorcontrib><creatorcontrib>Brown, Todd M.</creatorcontrib><creatorcontrib>Pogwizd, Steven M.</creatorcontrib><creatorcontrib>McElwee, Samuel K.</creatorcontrib><creatorcontrib>Gandotra, Sheetal</creatorcontrib><creatorcontrib>Russell, Derek W.</creatorcontrib><creatorcontrib>McElderry, H. Tom</creatorcontrib><creatorcontrib>Maddox, William R.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Pacing and clinical electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Colon, Chad M.</au><au>Barrios, James G.</au><au>Chiles, Joe W.</au><au>Brown, Todd M.</au><au>Pogwizd, Steven M.</au><au>McElwee, Samuel K.</au><au>Gandotra, Sheetal</au><au>Russell, Derek W.</au><au>McElderry, H. Tom</au><au>Maddox, William R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Atrial arrhythmia related outcomes in critically ill COVID‐19 patients</atitle><jtitle>Pacing and clinical electrophysiology</jtitle><addtitle>Pacing Clin Electrophysiol</addtitle><date>2021-05</date><risdate>2021</risdate><volume>44</volume><issue>5</issue><spage>814</spage><epage>823</epage><pages>814-823</pages><issn>0147-8389</issn><eissn>1540-8159</eissn><abstract>Rationale
Coronavirus disease 2019 (COVID‐19) is associated with many clinical manifestations including respiratory failure and cardiovascular compromise.
Objectives
We examine outcomes in critically ill individuals with COVID‐19 who develop atrial tachyarrhythmias.
Methods
We collected data from electrocardiograms and the electronic medical record of COVID‐19 positive (COVID+) and negative (COVID−) individuals admitted to our medical intensive care unit between February 29 and June 28, 2020. We compared clinical and demographic characteristics, new onset atrial tachyarrhythmia, hemodynamic compromise following atrial tachyarrhythmia, and in‐hospital mortality in COVID+ versus COVID−. Hemodynamic compromise was defined as having a new or increased vasopressor requirement or the need for direct current cardioversion for hemodynamic instability within 1 hour of atrial tachyarrhythmia onset.
Results
Of 300 individuals included, 200 were COVID+ and 100 were COVID−. Mean age was 60 ± 16 years, 180 (60%) were males, and 170 (57%) were African American. New onset atrial tachyarrhythmia occurred in 16% of COVID+ and 19% of COVID− individuals (P = .51). When compared to COVID− participants without atrial tachyarrhythmia, COVID+ individuals with new onset atrial tachyarrhythmia had higher mortality after multivariable adjustment (OR 5.0, 95% CI 1.9–13.5). New onset atrial tachyarrhythmia was followed by hemodynamic compromise in 18 COVID+ but no COVID− participants (P = .0001). COVID+ individuals with hemodynamic compromise after atrial tachyarrhythmia required increased ventilatory support at the time of atrial tachyarrhythmia onset.
Conclusions
Atrial tachyarrhythmia is associated with increased mortality in critically ill individuals with COVID‐19, especially those mechanically ventilated. Recognition of this could assist with clinical care for individuals with COVID‐19.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>33738812</pmid><doi>10.1111/pace.14221</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-3504-0451</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0147-8389 |
| ispartof | Pacing and clinical electrophysiology, 2021-05, Vol.44 (5), p.814-823 |
| issn | 0147-8389 1540-8159 |
| language | eng |
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| source | Wiley Online Library Journals Frontfile Complete |
| subjects | Arrhythmia atrial arrhythmias atrial fibrillation atrial flutter atrial tachycardia Cardiac arrhythmia Coronaviruses COVID-19 Electronic medical records Electrophysiology Mortality Tachyarrhythmia |
| title | Atrial arrhythmia related outcomes in critically ill COVID‐19 patients |
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