Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Department of Cardiology, Lady Davis Carmel Medical Center, Haifa, Israel.
Int J Cardiol. 2023 Dec 1;392:131298. doi: 10.1016/j.ijcard.2023.131298. Epub 2023 Aug 29.
Atrial fibrillation (AF) is associated with substantial morbidity and mortality. New-onset AF (NOAF) has been related recently to SARS-CoV-2 infection; however, the evidence supporting this link is still scarce. We aimed to examine the association between SARS-CoV-2 infection and NOAF.
We conducted a nested-case control study in a cohort of 2,931,046 adults from the largest healthcare provider in Israel. Subjects were followed from March 1st, 2020, until June 30th, 2022, for the occurrence of NOAF. Ten randomly selected controls were matched to each case of NOAF on age, sex, and duration of follow-up. Exposure to SARS-CoV-2 infection in the prior 30 days was assessed in cases and controls. To account for surveillance bias we performed a lag-time analysis and assessed the association with a negative control exposure (low back pain). Data was analyzed using conditional logistic regression.
During the follow-up 18,981 patients developed NOAF and were matched to 189,810 controls. The mean age of cases and matched controls was 73.8 ± 13 years, and 51.1% of them were women. Multivariable analysis showed that SARS-CoV-2 infection was associated with an increased risk of NOAF; adjusted-OR, 4.24 (95% CI, 3.89-4.62). The association remained significant on lag-time analysis; however, the strength of the association was gradually attenuated with increasing lag-time but stabilized around a lag-time of 20 days. The negative control exposure (low back pain) was associated only with small increased risk of NOAF; adjusted-OR of 1.13 (95% CI, 1.02-1.26).
SARS-CoV-2 infection appears to be associated with increased risk of NOAF.
心房颤动（AF）与大量发病率和死亡率有关。最近有研究表明，新发心房颤动（NOAF）与 SARS-CoV-2 感染有关；然而，支持这一联系的证据仍然很少。我们旨在研究 SARS-CoV-2 感染与 NOAF 之间的关系。
我们在以色列最大的医疗保健提供者的 2931046 名成年人中进行了一项嵌套病例对照研究。从 2020 年 3 月 1 日至 2022 年 6 月 30 日，对受试者进行了随访，以观察 NOAF 的发生。每例新发心房颤动患者匹配 10 例年龄、性别和随访时间相匹配的对照。在病例和对照中评估了 SARS-CoV-2 感染在过去 30 天内的暴露情况。为了考虑监测偏倚，我们进行了滞后时间分析，并评估了与阴性对照暴露（腰痛）的关联。使用条件逻辑回归分析数据。
在随访期间，有 18981 例患者发生了 NOAF，并与 189810 例对照相匹配。病例和匹配对照的平均年龄为 73.8±13 岁，其中 51.1%为女性。多变量分析表明，SARS-CoV-2 感染与 NOAF 的发生风险增加相关；调整后的比值比（OR）为 4.24（95%可信区间[CI]，3.89-4.62）。滞后时间分析结果仍然显著；然而，随着滞后时间的增加，关联的强度逐渐减弱，但在滞后时间约为 20 天时趋于稳定。阴性对照暴露（腰痛）仅与 NOAF 的风险略有增加相关；调整后的比值比（OR）为 1.13（95%CI，1.02-1.26）。
SARS-CoV-2 感染似乎与 NOAF 的发生风险增加有关。
