Ramon y Cajal hospital, Carretera de colmenar km 9,100, 28034 Madrid, Spain.
Cardiol J. 2021;28(1):34-40. doi: 10.5603/CJ.a2020.0145. Epub 2020 Nov 3.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has led to a paradigm shift in healthcare worldwide. Little is known about the impact on the cardiovascular system, and the incidence and consequences of new onset of atrial fibrillation (AF) in infected patients remain unclear. The aim of this study was to analyze the cardiovascular outcomes of patients with newonset AF and coronavirus disease 2019 (COVID-19) infection.
This observational study analyzed a sample of 160 consecutive patients hospitalized due to COVID-19. A group with new-onset AF (n = 12) was compared with a control group (total: n = 148, sinus rhythm: n = 118, previous AF: n = 30). New-onset AF patients were significantly older and hypertensive, as well as presenting more frequently with a history of acute coronary syndrome and renal dysfunction. This group showed a higher incidence of thromboembolic events (41.7% vs. 4.1%; p < 0.001), bleeding (33.3% vs. 4.7%, p = 0.005), a combined endpoint of thrombosis and death (58.3% vs. 19.6%, p = 0.006) and longer hospital stays (16.4 vs. 8.6 days, p < 0.001), with no differences in all-cause mortality.
In multivariate analysis, adjusted by potential confounding factors, new-onset AF demonstrated a 14.26 odds ratio for thromboembolism (95% confidence interval 2.86-71.10, p < 0.001).
New-onset AF in COVID-19 patients presumably has a notable impact on prognosis. The appearance of new-onset AF is related to worse cardiovascular outcomes, considering it as an independent predictor of embolic events. Further studies are needed to identify patients with COVID-19 at high risk of developing "de novo" AF, provide early anticoagulation and minimize the embolic risk of both entities.
严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）大流行导致全球医疗保健模式发生重大转变。对于冠状病毒疾病 2019（COVID-19）感染对心血管系统的影响知之甚少，新发生的心房颤动（AF）的发病率和后果仍不清楚。本研究旨在分析新发 AF 与 COVID-19 感染患者的心血管结局。
本观察性研究分析了因 COVID-19 住院的 160 例连续患者的样本。新发 AF 组（n = 12）与对照组（总：n = 148，窦性节律：n = 118，既往 AF：n = 30）进行比较。新发 AF 患者年龄较大且患有高血压，更常伴有急性冠状动脉综合征和肾功能不全病史。该组血栓栓塞事件发生率较高（41.7% vs. 4.1%；p < 0.001），出血（33.3% vs. 4.7%，p = 0.005），血栓形成和死亡的联合终点（58.3% vs. 19.6%，p = 0.006）和更长的住院时间（16.4 天 vs. 8.6 天，p < 0.001），但全因死亡率无差异。
在多变量分析中，通过潜在混杂因素进行调整后，新发 AF 血栓栓塞的优势比为 14.26（95%置信区间 2.86-71.10，p < 0.001）。
COVID-19 患者新发 AF 对预后有明显影响。新发 AF 的出现与心血管结局恶化有关，可作为栓塞事件的独立预测因子。需要进一步研究以确定 COVID-19 患者发生“新发”AF 的高风险人群，提供早期抗凝治疗，并尽量降低两种疾病的栓塞风险。
