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

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

doi:10.3389/fcvm.2021.763827

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

Front Cardiovasc Med. 2021 Nov 24:8:763827. doi: 10.3389/fcvm.2021.763827. eCollection 2021.

Authors

Peter Jirak¹, Zornitsa Shomanova², Robert Larbig^{3

4}, Daniel Dankl⁵, Nino Frank⁵, Clemens Seelmaier¹, Dominyka Butkiene⁴, Michael Lichtenauer¹, Moritz Mirna¹, Bernhard Strohmer¹, Jan Sackarnd², Uta C Hoppe¹, Jürgen Sindermann², Holger Reinecke², Gerrit Frommeyer³, Lukas J Motloch¹, Rudin Pistulli²

Affiliations

¹ Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
² Department of Cardiology I-Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Münster, Germany.
³ Department of Cardiology II-Electrophysiology, University Hospital Münster, Münster, Germany.
⁴ Division of Cardiology, Hospital Maria Hilf Mönchengladbach, Mönchengladbach, Germany.
⁵ Department of Anesthesiology, Perioperative Care, and Intensive Care Medicine, University Hospital Salzburg, Paracelsurs Medical University, Salzburg, Austria.

Abstract

Aims: 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. Methods and Results: This retrospective study included 120 critically ill patients requiring mechanical ventilation in three European tertiary hospitals, including n =60 COVID-19, matched according to risk factors for the occurrence of arrhythmias in n = 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 %, p = ns and asystole 5.0 vs. 3.3%, p = ns) with consequent similar rates of cardiopulmonary resuscitation (6.7 vs. 10.0%, p = ns). AF was even more common in non-COVID-19 (AF 18.3 vs. 43.3%, p = 0.003; newly onset AF 10.0 vs. 30.0%, p = 0.006), which resulted in a higher need for electrical cardioversion (6.7 vs. 20.0%, p = 0.029). Despite these findings and comparable rates of therapeutic anticoagulation (TAC), the incidence of stroke was higher in COVID-19 (6.7.% vs. 0.0, p = 0.042). These events also happened in the absence of AF (50%) and with TAC (50%). Conclusions: 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.

Keywords: COVID-19; anticoagulation; arrhythmias; atrial fibrillation; pneumonia; stroke; ventricular tachycardia.