ABSTRACT
Background and Aims: Subclinical atrial fibrillation (SCAF) is an asymptomatic, short and fast atrial arrhythmia observed during long-term monitoring. SCAF incidence ranges between 5-15% in critical illness and is associated to an increased risk of one-yeardeath, while its role in thromboembolism is debated. With this pilot study, we assessed SCAF incidence in a longitudinal cohort of moderate-to-severe CoViD-19, evaluating its association with inhospital death, major bleeding or thromboembolism. Methods: We considered all the subjects admitted to our subintensive medicine department for moderate-to-severe CoViD-19 undergoing to continuous ECG monitoring for at least seven consecutive days, evaluating the occurrence of SCAF daily. We also collected history, ECG, age, sex, occurrence of in-hospital death, thromboembolism and major bleeding. Results: Of 34 consecutive patients, 4 were excluded for pre-existing atrial fibrillation. We analysed 30 subjects who completed ECG monitoring: mean age was 66±14.8 years, 47% were females. SCAF incidence was 20% in 7 days. During the admission we observed 6(20%) deaths, 2(6%) thromboembolic events and 2(6%) major bleedings, with no relationship with SCAF occurrence. SCAF was more frequently observed in severe than in moderate CoViD-19 (p=0.0001). Conclusions: SCAF shows high incidence in CoViD-19, especially within a severe disease. This pilot study did not underline an association with short-term events: we are expanding our cohort and performing a longer follow-up to validate our data and to assess associations with post-CoViD events.
ABSTRACT
Background and Aims: Subclinical atrial fibrillation (SCAF) is defined as a fast, asymptomatic and self-terminating arrhythmic event, often diagnosed by long-term monitoring. We observed a high SCAF prevalence in moderate-to-severe CoViD-19. We aimed to assess the determinants of SCAF in this cohort. Methods: All the consecutive patients affected by moderate-tosevere CoViD-19 admitted in a subintensive CoViD-19 unit were enrolled;each patient was submitted to continuous ECG monitoring for 7 days;for each subject, we collected - at the admission - age, sex, BMI, history of heart failure, history of hypertension, history of COPD, LUSS score, 12-leads ECG (calculating intervals and assessing the most common alterations), BNP, Troponin I and PaO2/FiO2. Results: We obtained 34 consecutive patients;4 patients were excluded for pre-existing atrial fibrillation;SCAF was observed in 20% of the sample;age, sex, BMI, history of heart failure, hypertension and COPD, all the ECG intervals (PR, QRS and ST), ECG alterations (atrioventricular blocks, intraventricular blocks, hypertrophy or ischemia), BNP, Troponin I and PaO2/FiO2 did not result statistically associated with SCAF. Patient developing SCAF had a higher LUSS score resulted significantly associated to SCAF (LUSS in no-SCAF: 15.36±5,38;LUSS in SCAF: 20,0±4,27;p=0,027), even after Bonferroni correction. Conclusions: SCAF has a high prevalence in CoViD-19 and seems to be correlated more to the disease severity than to the classical risk factors for atrial fibrillation. Larger cohorts are required to validate our observations.