AUTHOR=Cozzolino Domenico , Romano Ciro , Nevola Riccardo , Marrone Aldo , Umano Giuseppina R. , Cuomo Giovanna , Rinaldi Luca , Adinolfi Luigi E. ,  Vanvitelli COVID Collaborators , Marianna Abitabile , Domenico Beccia , Chiara Brin , Caterina Carusone , Francesca Cinone , Sara Colantuoni , Micol Del Core , Klodian Gjeloshi , Simona Imbriani , Domenico Macaro , Giulia Medicamento , Luciana Meo , Francesco Nappo , Andrea Padula , Roberta Ranieri , Carmen Ricozzi , Carolina Ruosi , Ausilia Sellitto , Pino Sommese , Angela Villani , Catalini Christian 

TITLE=COVID-19 and arrhythmia: The factors associated and the role of myocardial electrical impulse propagation. An observational study based on cardiac telemetric monitoring

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.912474

DOI=10.3389/fcvm.2022.912474

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>The heart is commonly involved in COVID-19, and rhythm disorders have been largely reported.</p></sec><sec><title>Objective</title><p>To evaluate the association of some non-cardiac and cardiac comorbidities and QT dispersion with arrhythmias and their impact on outcomes in hospitalized patients with COVID-19.</p></sec><sec><title>Methods</title><p>Each patient underwent cardiac telemetry monitoring through the entire hospitalization period, laboratory analyses, 12-lead ECG, and lung imaging examination. Patients with arrhythmia were divided into three groups (bradyarrhythmias, tachyarrhythmias, and tachy- and bradyarrhythmias).</p></sec><sec><title>Results</title><p>Two-hundred patients completed the study (males, 123; mean age, 70.1 years); of these, 80 patients (40%) exhibited rhythm disorders on telemetry. Patients with arrhythmia were older (<italic>p</italic> &lt; 0.0001), had a greater number of comorbidities (<italic>p</italic> &lt; 0.0001), higher values of creatinine (<italic>p</italic> = 0.007), B-type natriuretic peptide (<italic>p</italic> &lt; 0.0001), troponin (<italic>p</italic> &lt; 0.0001), C-reactive protein (<italic>p</italic> = 0.01), ferritin (<italic>p</italic> = 0.001), D-dimer (<italic>p</italic> &lt; 0.0001), procalcitonin (<italic>p</italic> = 0.0008), QT interval (<italic>p</italic> = 0.002), QTc interval (<italic>p</italic> = 0.04), and QTc dispersion (<italic>p</italic> = 0.01), and lower values of sodium (<italic>p</italic> = 0.03), magnesium (<italic>p</italic> = 0.04), glomerular filtration rate (<italic>p</italic> &lt; 0.0001), and hemoglobin (<italic>p</italic> = 0.008) as compared to patients without arrhythmia. By comparing the three subgroups of patients, no significant differences were found. At multivariate analysis, age [odds ratio (OR) = 1.14 (95% CI: 1.07–1.22); <italic>p</italic> = 0.0004], coronary artery disease [OR = 12.7 (95% CI: 2.38–68.01); <italic>p</italic> = 0.005], and circulating troponin [OR = 1.05 (95% CI: 1.003–1.10); <italic>p</italic> = 0.04] represented risk factors independently associated with arrhythmia. All-cause in-hospital mortality was ∼40-fold higher among patients with arrhythmia [OR = 39.66 (95% CI: 5.20–302.51); <italic>p</italic> = 0.0004].</p></sec><sec><title>Conclusion</title><p>Arrhythmias are associated with aging, coronary artery disease, subtle myocardial injury, hyperinflammatory status, coagulative unbalance, and prolonged QTc dispersion in patients with COVID-19, and confer a worse in-hospital prognosis. Given its usefulness, routinary use of cardiac telemetry should be encouraged in COVID wards.</p></sec>