COVID-19 Associated Myocardial Injury and Arrhythmias

BackgroundCOVID-19 is a systemic illness with broad organ involvement, including the cardiovascular system. While arrhythmias are commonly observed in COVID-19 patients, reports on their incidence, predictors of sudden cardiac death, therapeutic strategies, and both short-term and long-term outcomes remain heterogeneous. MethodsIn this retrospective, multicenter study, we evaluated the cohort of patients hospitalized for COVID-19 (RT-PCR confirmed) at Newark Beth Israel Medical Center and Monmouth Medical Center between March 1 and April 30, 2020. This study was approved by the institutional review board. We aimed to assess the incidence of new-onset arrhythmias and major adverse cardiovascular events (MACE), comparing these outcomes in patients admitted to the intensive care unit (ICU) versus those in non-ICU settings. ResultsA total of 720 patients were hospitalized for COVID-19 during the study period. The mean age of the cohort was 63.48 years, with 54% male. The incidence of new-onset tachyarrhythmias was significantly higher in the ICU cohort (19%) compared to the non-ICU cohort (8%). The ICU group also experienced a markedly higher incidence of MACE (78% vs. 22%). In-patient mortality was significantly higher in the ICU group (70% vs. 14%). Multivariate regression analysis revealed that ICU admission was an independent risk factor for developing new-onset arrhythmias, with an odds ratio (OR) of 15.92 (95% CI 10.15-24.97; p < 0.001). In patients without MACE, in-hospital mortality was only 1.6%, whereas mortality was 77.4% in those with MACE. ICU admission also emerged as an independent risk factor for MACE, increasing the odds by 15-fold, adjusted for age and gender (OR 15.39, 95% CI 8.36-28.33; p < 0.001). ConclusionICU admission is a significant independent risk factor for both new-onset arrhythmias and MACE in COVID-19 patients. The high rates of these adverse outcomes in the ICU population are likely due to the severity of the systemic inflammatory response in COVID-19, rather than a direct viral-mediated cardiovascular effect.