Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany; DZHK (German Center of Cardiovascular Research), partner site Berlin, Germany.
DZHK (German Center of Cardiovascular Research), partner site Berlin, Germany; Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.
J Electrocardiol. 2021 May-Jun;66:102-107. doi: 10.1016/j.jelectrocard.2021.04.001. Epub 2021 Apr 16.
Patients with COVID-19 seem to be prone to the development of arrhythmias. The objective of this trial was to determine the characteristics, clinical significance and therapeutic consequences of these arrhythmias in COVID-19 patients requiring intensive care unit (ICU) treatment.
A total of 113 consecutive patients (mean age 64.1 ± 14.3 years, 30 (26.5%) female) with positive PCR testing for SARS-CoV2 as well as radiographically confirmed pulmonary involvement admitted to the ICU from March to May 2020 were included and observed for a cumulative time of 2321 days. Fifty episodes of sustained atrial tachycardias, five episodes of sustained ventricular arrhythmias and thirty bradycardic events were documented. Sustained new onset atrial arrhythmias were associated with hemodynamic deterioration in 13 cases (35.1%). Patients with new onset atrial arrhythmias were older, showed higher levels of Hs-Troponin and NT-proBNP, and a more severe course of disease. The 5 ventricular arrhythmias (two ventricular tachycardias, two episodes of ventricular fibrillation, and one torsade de pointes tachycardia) were observed in 4 patients. All episodes could be terminated by immediate defibrillation/cardioversion. Five bradycardic events were associated with hemodynamic deterioration. Precipitating factors could be identified in 19 of 30 episodes (63.3%), no patient required cardiac pacing. Baseline characteristics were not significantly different between patients with or without bradycardic events.
Relevant arrhythmias are common in severely ill ICU patients with COVID-19. They are associated with worse courses of disease and require specific treatment. This makes daily close monitoring of telemetric data mandatory in this patient group.
COVID-19 患者似乎容易发生心律失常。本试验的目的是确定需要重症监护病房（ICU）治疗的 COVID-19 患者中这些心律失常的特征、临床意义和治疗后果。
共纳入 113 例连续患者（平均年龄 64.1 ± 14.3 岁，30 例（26.5%）为女性），PCR 检测 SARS-CoV2 呈阳性，且影像学证实肺部受累，于 2020 年 3 月至 5 月入住 ICU，并观察了 2321 天。记录了 50 例持续性房性心动过速、5 例持续性室性心律失常和 30 例缓慢性心律失常事件。13 例（35.1%）新发生的持续性房性心律失常与血流动力学恶化有关。新发房性心律失常患者年龄较大，hs-Troponin 和 NT-proBNP 水平较高，疾病严重程度更高。4 例患者发生 5 例（2 例室性心动过速、2 例心室颤动、1 例尖端扭转型室速）新发室性心律失常。所有发作均可通过立即除颤/复律终止。5 例缓慢性心律失常与血流动力学恶化有关。19 例（63.3%）发作可识别诱发因素，无患者需要心脏起搏。有或无缓慢性心律失常的患者之间的基线特征无显著差异。
在患有 COVID-19 的重症 ICU 患者中，相关心律失常很常见。它们与疾病的严重程度相关，需要特定的治疗。这使得在该患者群体中必须每天密切监测遥测数据。
