Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Pacing Clin Electrophysiol. 2021 May;44(5):814-823. doi: 10.1111/pace.14221. Epub 2021 Mar 31.
Coronavirus disease 2019 (COVID-19) is associated with many clinical manifestations including respiratory failure and cardiovascular compromise.
We examine outcomes in critically ill individuals with COVID-19 who develop atrial tachyarrhythmias.
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.
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.
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.
2019 年冠状病毒病（COVID-19）与许多临床表现有关，包括呼吸衰竭和心血管功能障碍。
我们研究了在因 COVID-19 而住进重症监护病房的危重患者中出现房性心动过速的患者的结局。
我们收集了 2020 年 2 月 29 日至 6 月 28 日期间住进我们的内科重症监护病房的 COVID-19 阳性（COVID）和 COVID-19 阴性（COVID）患者的心电图和电子病历数据。我们比较了 COVID 和 COVID 患者的临床和人口统计学特征、新发房性心动过速、房性心动过速后出现的血液动力学障碍以及院内死亡率。血液动力学障碍的定义为新发或增加血管加压药需求，或因房性心动过速发作后 1 小时内出现血液动力学不稳定而需要直流电复律。
在 300 名患者中，200 名为 COVID 患者，100 名为 COVID 患者。平均年龄为 60±16 岁，180 名（60%）为男性，170 名（57%）为非裔美国人。COVID 患者中有 16%出现新发房性心动过速，COVID 患者中有 19%出现新发房性心动过速（P=0.51）。与没有房性心动过速的 COVID 患者相比，新发房性心动过速的 COVID 患者经多变量校正后死亡率更高（比值比 5.0，95%置信区间 1.9-13.5）。COVID 患者新发房性心动过速后出现血液动力学障碍 18 例，但 COVID 患者无此情况（P=0.0001）。COVID 患者在房性心动过速发作时需要增加通气支持以应对血液动力学障碍。
房性心动过速与 COVID-19 危重患者的死亡率增加相关，尤其是那些需要机械通气的患者。认识到这一点可能有助于 COVID-19 患者的临床护理。
