AUTHOR=Jirak Peter , Shomanova Zornitsa , Larbig Robert , Dankl Daniel , Frank Nino , Seelmaier Clemens , Butkiene Dominyka , Lichtenauer Michael , Mirna Moritz , Strohmer Bernhard , Sackarnd Jan , Hoppe Uta C. , Sindermann Jürgen , Reinecke Holger , Frommeyer Gerrit , Motloch Lukas J. , Pistulli Rudin 

TITLE=Higher Incidence of Stroke in Severe COVID-19 Is Not Associated With a Higher Burden of Arrhythmias: Comparison With Other Types of Severe Pneumonia

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.763827

DOI=10.3389/fcvm.2021.763827

ISSN=2297-055X

ABSTRACT=<p><bold>Aims:</bold> Thromboembolic events, including stroke, are typical complications of COVID-19. Whether arrhythmias, frequently described in severe COVID-19, are disease-specific and thus promote strokes is unclear. We investigated the occurrence of arrhythmias and stroke during rhythm monitoring in critically ill patients with COVID-19, compared with severe pneumonia of other origins.</p><p><bold>Methods and Results:</bold> This retrospective study included 120 critically ill patients requiring mechanical ventilation in three European tertiary hospitals, including <italic>n</italic> =60 COVID-19, matched according to risk factors for the occurrence of arrhythmias in <italic>n</italic> = 60 patients from a retrospective consecutive cohort of severe pneumonia of other origins. Arrhythmias, mainly atrial fibrillation (AF), were frequent in COVID-19. However, when compared with non-COVID-19, no difference was observed with respect to ventricular tachycardias (VT) and relevant bradyarrhythmias (VT 10.0 vs. 8.4 %, <italic>p</italic> = <italic>ns</italic> and asystole 5.0 vs. 3.3%, <italic>p</italic> = <italic>ns</italic>) with consequent similar rates of cardiopulmonary resuscitation (6.7 vs. 10.0%, <italic>p</italic> = <italic>ns</italic>). AF was even more common in non-COVID-19 (AF 18.3 vs. 43.3%, <italic>p</italic> = <italic>0.003</italic>; newly onset AF 10.0 vs. 30.0%, <italic>p</italic> = <italic>0.006</italic>), which resulted in a higher need for electrical cardioversion (6.7 vs. 20.0%, <italic>p</italic> = <italic>0.029</italic>). Despite these findings and comparable rates of therapeutic anticoagulation (TAC), the incidence of stroke was higher in COVID-19 (6.7.% vs. 0.0, <italic>p</italic> = <italic>0.042</italic>). These events also happened in the absence of AF (50%) and with TAC (50%).</p><p><bold>Conclusions:</bold> Arrhythmias were common in severe COVID-19, consisting mainly of AF, yet less frequent than in matched pneumonia of other origins. A contrasting higher incidence of stroke independent of arrhythmias also observed with TAC, seems to be an arrhythmia-unrelated disease-specific feature of COVID-19.</p>