Department of Internal Medicine, University of Nevada, Reno, School of Medicine, Reno, NV, USA.
Dr. D. Y. Patil Medical College, Hospital & Research Centre, Maharashtra, India.
Ann Noninvasive Electrocardiol. 2021 Jul;26(4):e12833. doi: 10.1111/anec.12833. Epub 2021 Mar 19.
Cardiovascular events have been reported in the setting of coronavirus disease-19 (COVID-19). It has been hypothesized that systemic inflammation may aggravate arrhythmias or trigger new-onset conduction abnormalities. However, the specific type and distribution of electrocardiographic disturbances in COVID-19 as well as their influence on mortality remain to be fully characterized.
Electrocardiograms (ECGs) were obtained from 186 COVID-19-positive patients at a large tertiary care hospital in Northern Nevada. The following arrhythmias were identified by cardiologists: sinus bradycardia, sinus tachycardia, atrial fibrillation (A-Fib), atrial flutter, multifocal atrial tachycardia (MAT), premature atrial contraction (PAC), premature ventricular contraction (PVC), atrioventricular block (AVB), and right bundle branch block (RBBB). The mean PR interval, QRS duration, and corrected QT interval were documented. Fisher's exact test was used to compare the ECG features of patients who died during the hospitalization with those who survived. The influence of ECG features on mortality was assessed with multivariable logistic regression analysis.
A-Fib, atrial flutter, and ST-segment depression were predictive of mortality. In addition, the mean ventricular rate was higher among patients who died as compared to those who survived. The use of therapeutic anticoagulation was associated with reduced odds of death; however, this association did not reach statistical significance.
The underlying pathogenesis of COVID-19-associated arrhythmias remains to be established, but we postulate that systemic inflammation and/or hypoxia may induce potentially lethal conduction abnormalities in affected individuals. Longitudinal studies are warranted to evaluate the risk factors, pathogenesis, and management of COVID-19-associated cardiac arrhythmias.
在新型冠状病毒病-19（COVID-19）的背景下，已报告心血管事件。有人假设全身炎症可能会加重心律失常或引发新的传导异常。然而，COVID-19 中的心电图（ECG）异常的具体类型和分布以及它们对死亡率的影响仍有待充分描述。
从内华达州北部一家大型三级保健医院的 186 例 COVID-19 阳性患者中获取心电图（ECG）。心脏病专家通过以下心律失常进行识别：窦性心动过缓、窦性心动过速、心房颤动（A-Fib）、心房扑动、多灶性房性心动过速（MAT）、房性期前收缩（PAC）、室性期前收缩（PVC）、房室传导阻滞（AVB）和右束支传导阻滞（RBBB）。记录平均 PR 间隔、QRS 持续时间和校正 QT 间隔。Fisher 确切检验用于比较住院期间死亡患者和存活患者的 ECG 特征。多变量逻辑回归分析评估 ECG 特征对死亡率的影响。
A-Fib、心房扑动和 ST 段压低与死亡率相关。此外，与存活患者相比，死亡患者的平均心室率更高。与死亡相比，使用治疗性抗凝治疗的可能性降低；但是，这种关联没有达到统计学意义。
COVID-19 相关心律失常的潜在发病机制仍有待确定，但我们推测全身炎症和/或缺氧可能会导致受影响个体发生潜在致命的传导异常。需要进行纵向研究，以评估 COVID-19 相关心脏心律失常的危险因素、发病机制和管理。
