The study of hundreds of hospitalized patients found that cardiac arrest and heart rhythm disorders are 10 times more common among COVID-19 patients requiring intensive care than among other hospitalized COVID-19 patients.
Just why the risk soars so high in the ICU isn't clear, but it's likely tied to the stresses of advanced illness, not a direct activity of the new coronavirus upon the heart, said study senior author Dr. Rajat Deo. He's a cardiac electrophysiologist and associate professor of cardiovascular medicine at the University of Pennsylvania School of Medicine.
"Non-cardiac causes such as systemic infection, inflammation and illness are likely to contribute more to the occurrence of cardiac arrest and arrhythmias than damaged or infected heart cells due to the viral infection," Deo said in a university news release.
A cardiologist unconnected to the new report agreed.
"We know that critical ill patients with COVID-19 have what we call a systemic inflammatory response, which creates a 'cytokine storm,'" said Dr. Satjit Bhusri, from Lenox Hill Hospital in New York City. "This massive immune response, it appears, is the cause of the increase in heart rhythm disorders, rather than virus itself."
The new study included 700 COVID-19 patients, mean age 50, who were admitted to the Hospital of the University of Pennsylvania between early March and mid-May. More than 70% of the patients were Black.
Overall, nine patients suffered cardiac arrest; 25 developed the irregular heartbeat known as atrial fibrillation; nine had clinically significant bradyarrhythmias (slow heart rhythms); and 10 had "non-sustained ventricular tachycardia events" -- a rapid heart rate that stops by itself within 30 seconds.
Of the patients in the study, about 11% were admitted to the ICU. The only cases of cardiac arrest occurred among patients in the ICU, according to the findings published June 22 in the journal Heart Rhythm.
All of this echoes early reports that had suggested there was a high rate of heart rhythm problems among all COVID-19 patients, even those who are relatively young.
"In order to best protect and treat patients who develop COVID-19, it's critical for us to improve our understanding of how the disease affects various organs and pathways within our body -- including our heart rhythm abnormalities," Deo said.
Dr. Laurence Epstein is system director of electrophysiology at Northwell Health in Manhasset, N.Y. Reading over the new findings, he said that the high rate of heart arrhythmias in COVID-19 "is not surprising given the severity of illness in many hospitalized COVID patients." He noted that the rate of atrial fibrillation described in the Pennsylvania study (3.6%) is actually much lower than the rate of 19% he's witnessed among Northwell Health patients.
And what about any long-term consequences for survivors?
"More research is needed to assess whether the presence of cardiac arrhythmias have long-term health effects on patients who were hospitalized for COVID-19," Deo said. "In the meantime, it's important that we launch studies to evaluate the most effective and safest strategies for long-term [anti-clotting] and rhythm management in this population."
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