Diagnostic accuracy of sinus tachycardia as an independent clinical indicator among different COVID-19 variants

Background. The most common arrhythmia which have been reported frequently in COVID-19 patients is sinus tachy-cardia. As COVID-19 is usually misdiagnosed with other respiratory tract diseases, introduction of a rapid clinical indicator for out of proportional sinus tachycardia in the diagnosis of COVID-19 during the early viral replication stage is essential for better cost-effective use of resources.Objectives. This study was conducted to determine the diagnostic accuracy of sinus tachycardia as an independent indicator of COVID-19.Material and methods. This is a cross-sectional analytical study. It included 152 healthcare workers who fulfilled the inclusion criteria. Multiple logistic regression analysis was conducted to investigate the factors associated with COVID-19 among the entire study sample and among each group.Results. Among our participants, 32.9% were male, while 67.1% were female, with a mean age of 35.47 +/- 7.09 years. It was found that 51.3% of our sample were COVID-19 PCR positive, and the mean number of days of symptoms at presentation was 2.01 +/- 1.29. It was found that the prevalence of out of proportional sinus tachycardia among the participants diagnosed with COVID-19 in 2021 was triple that of the participants who were recruited in 2020 (61%, 26%, respectively). It was found that there was significant association between pulse rate and COVID-19, with gender, age, temperature or days of symptoms having no effect.Conclusions. The study highlights the diagnostic accuracy of sinus tachycardia as an independent indicator of COVID-19, especially the Omicron variant, as a higher pulse rate is associated with higher odds of having COVID-19

Catheter ablation of cardiac arrhythmias during COVID-19 pandemic in Cambodia

Catheter ablations of cardiac arrhythmias are nowadays frequently guided by electro-anatomic mapping systems. Technical staff with medical training, or medical staff with technical training, is needed to assist the operator. Travel restrictions because of current COVID-19 pandemics have limited the in person availability for technical support staff. These limitations make us to perform the feasibility of remote support with an internet based communication platform. A total cardiac arrhythmias 25 patients (Male: 10 cases, Female: 15 cases) with different arrhythmias such as Atrial fibrillation (1 case), Atrial flutter (5 cases), Atrial tachycardia (2 cases), Right and Left Ventricular Arrhythmias (19 cases), having undergone ablation procedures between 2020 to 2022. Acute procedure success was obtained 25 cases, no complications. Our experience with remote support for electro-anatomic mapping for complex electrophysiological ablation procedures, showed the feasibility and safety of this approach. It increases the availability of technical support for reducing the costs. Remote support for electroanatomic mapping may therefore facilitate continuous care for patients with arrhythmias during the COVID-19 pandemics. As a result of its advantages beyond COVID-19 pandemics related problems, it will likely play a greater role in the future.

Cardiac Arrhythmias in Post-COVID Syndrome: Prevalence, Pathology, Diagnosis, and Treatment.

An increase in post-COVID patients with late sequelae of acute COVID-19 infection is emerging as an ongoing challenge for physicians and healthcare professionals. Since the beginning of the pandemic, it has rapidly become evident that the acute infection is not limited to the respiratory tract but that several organs, including the cardiovascular system, can be affected. Moreover, in a significant proportion of patients (ranging from about 10 to up to 50%) with former COVID-19, cardiopulmonary symptoms such as dyspnea, palpitations, restricted physical capacity, and cardiac arrhythmias can persist weeks and months after the acute SARS-CoV-2 infection. The spectrum of COVID-19-associated arrhythmias is rather wide, most likely due to various pathomechanisms. In this article, the prevalence of cardiac arrhythmias and underlying pathologies are reviewed, including direct myocardial injury and abnormal consequences with an impact on cardiac electric instability. The hyperinflammatory reaction of the host immune system is specifically considered. Moreover, several distinct rhythm disorders occurring in post-COVID patients are discussed with regard to their clinical management.

Cardiovascular Complications in Patients Hospitalized for COVID-19: A Cohort Study in Havana, Cuba.

INTRODUCTION AND OBJECTIVE: At least one in ten patients infected with COVID develop cardiovascular complications during hospitalization, increasing the number of deaths from this cause. However, the determinants of risk are not clearly elucidated. This study aims to determine whether there is a relationship between in-hospital cardiac complications and cardiovascular history and hospital evolution. METHODS: Prospective cohort study of 373 patients with a positive diagnosis of SARS-CoV-2 admitted to an Intensive Care Unit between March and October 2021. RESULTS: Median age was 69 (IQR: 57-77), 29.2 % of patients presented cardiovascular complications: 21.2 % electrical, 5.9 % acute coronary syndrome and 1.9 % pulmonary thromboembolism. Age RR: 1.02 (95 % CI: 1.00-1.04; p = 0.020) and history of ischemic heart disease RR: 2.23 (95 % CI: 1.27-3.92; p = 0.005) were identified as independent predictors of in-hospital cardiac complications. CONCLUSIONS: Age and history of ischemic heart disease were identified as independent predictor variables of cardiovascular complications in patients admitted with severe COVID-19 involvement; being significantly associated with lower survival.

Az influenza mint kardiológiai rizikótényezo és a vakcináció szerepe a kockázat csökkentésében.

The different types of cardiovascular diseases, including coronary heart disease, cardiac arrhythmias and heart failure are highly prevalent in the society. Cardiovascular diseases are the leading cause of mortality. Although the influenza is forced out from the mainstream of thinking nowadays because of the ongoing SARS-CoV-2 pandemic, it still has its serious epidemiological significance. The seasonal influenza epidemic often contributes to mortality mainly, but not exclusively among old, multi-morbid patients. There are a vast number of scientific publications and evidence which prove and emphasize the synergic health-destroying and mortality-increasing effect of co-existing cardiovascular disease and influenza. Moreover, the beneficial effect of vaccination against influenza infection and its major role in prevention is also well documented. The SARS-CoV-2 pandemic enforces the importance of influenza vaccination because both viruses can lead to severe or often fatal disease, especially among old and frail patients. In addition, the younger population can be far more vulnerable against the novel coronavirus in the case of a co-existing influenza infection. International guidelines recommend influenza vaccination for patients having heart disease, like for other high-risk populations. Despite the nationally reimbursed, cost-free vaccines, the influenza vaccination rate of the society is still low not just in Hungary but also internationally. The authors review the effect of influenza infection on heart diseases, and draw attention to the role of influenza vaccination in decreasing cardiovascular morbidity and mortality. Orv Hetil. 2022; 163(40): 1585-1596.

Cardiologic evaluation of Turkish mitochondrial fatty acid oxidation disorders.

BACKGROUND: Mitochondrial fatty acid oxidation disorders (FAODs) cause impairment in energy metabolism and can lead to a spectrum of cardiac pathologies including cardiomyopathy and arrhythmias. The frequency of underlying cardiac pathologies and the response to recommended treatment in FAODs was investigated. METHODS: Sixty-eight children (35 males, 33 females) with the diagnosis of a FAOD were included in the study. Cardiac function was evaluated with 12-lead standard electrocardiography, echocardiography, and 24 h Holter monitoring. RESULTS: Forty-five patients (66%) were diagnosed after disease symptoms developed and 23 patients (34%) were diagnosed in the pre-symptomatic period. Among symptomatic patients (n: 45), cardiovascular findings were detected in 18 (40%) patients, including cardiomyopathy in 14 (31.1%) and conduction abnormalities in 4 (8.8%) patients. Cardiac symptoms were more frequently detected in primary systemic carnitine deficiency (57.1%). Patients with multiple acyl-CoA dehydrogenase, long-chain 3-hydroxyacyl-CoA dehydrogenase, and mitochondrial trifunctional protein deficiencies also had an increased frequency of cardiac symptoms. Patients with medium-chain acyl-CoA dehydrogenase, very long-chain acyl-CoA dehydrogenase, and carnitine palmitoyltransferase I deficiencies had a lower prevalence of cardiac symptoms both during admission and during clinical follow up. Cardiomyopathy resolved completely in 8/14 (57%) patients and partially in 2/14 (14.3%) patients with treatment. Two patients with cardiomyopathy died in the newborn period; cardiomyopathy persisted in 1 (7.1%) patient with very long-chain acyl-CoA dehydrogenase deficiency. CONCLUSION: Early diagnosis, treatment and follow up made a significant contribution to the improvement of cardiac symptoms of patients with FAODs.

The relationship between length of stay in intensive care unit and Tpeak-Tend and Tpeak-Tend/QTc ratio in COVID 19 patients with acute coronary syndrome.

Background: Patients with coronavirus disease 2019 (COVID-19) can develop cardiac injury resulting in cardiac arrhythmias, myocarditis, and acute coronary syndrome (ACS). In this study, we aimed to investigate whether COVID-19 infection affects ventricular repolarization parameters such as Tpeak-Tend interval (Tp-e), QT interval, corrected QT (QTc), Tp-e/QT, and Tp-e/cQT in patients with ACS. Methods: The study consisted of two groups. The first group included patients with ACS and COVID-19 (Group 1) (n = 50). Polymerase chain reaction test positive patients were enrolled. The second group included patients with only ACS (Group 2) (n = 100). The risk of ventricular arrhythmias was evaluated on the basis of the measured electrocardiographic Tp-e and QT interval, and QTc, Tp-e/QT, and Tp-e/QTc values. Results: Tp-e interval, QTc, and Tp-e/QTc were significantly higher in the group1 than group 2 (p < .001, p < .018, and p < .001, respectively). Significant positive correlations were found between Tp-e, D-dimer level, and C-reactive protein (CRP) level in the group1 (p = .002, p = 0 .03, and p = .021, respectively). Univariate and multivariate regression analyses revealed that Tp-e was one of the independent predictor of length of stay in the intensive care unit (ICU). (B = 1.662, p = .006 and B = 1.804, p = .021, respectively). Conclusions: In the patients with ACS, COVID-19 infection caused increases in QTc, Tp-e, and Tp-e/QTc ratio. In addition, age and prolonged Tp-e were found to be independent predictors of prolonged ICU stay.

Clinical Management of New-Onset Atrial Fibrillation in COVID-19 Patients Referred to a Tertiary Cardiac Arrhythmia Center after Hospital Discharge.

BACKGROUND: Available reports on the post-discharge management of atrial fibrillation (AF) in COVID-19 patients are scarce. The aim of this case series was to describe the clinical outcomes of new-onset AF in COVID-19 patients referred to a tertiary cardiac arrhythmia center after hospital discharge. METHODS: All consecutive patients referred to our center for an ambulatory evaluation from 18 May 2020 to 15 March 2022 were retrospectively screened. Patients were included in the current analysis if new-onset AF was diagnosed during hospitalization for COVID-19 and then referred to our clinic. RESULTS: Among 946 patients, 23 (2.4%) were evaluated for new-onset AF during COVID-19. The mean age of the study cohort was 71.5 ± 8.1 years; 87.0% were male. Median time from COVID-19 discharge and the first ambulatory evaluation was 53 (41.5-127) days; median follow-up time was 175 (83-336) days. At the in-office evaluation, 14 (60.9%) patients were in sinus rhythm, and nine patients were in AF. In 13.0% of cases, oral anticoagulation was stopped according to CHADS-VASc. Eight patients in AF were scheduled for electrical cardioversion; one patient was rate-controlled. Four patients were treated with catheter ablation (CA) during follow-up. Two post-cardioversion AF recurrences were detected during follow-up, while no recurrences were diagnosed among patients who underwent CA. CONCLUSION: Our data suggest that AF may not be considered as a simple bystander of the in-hospital COVID-19 course. Management of new-onset AF in post-COVID-19 patients referred to our clinic did not significantly differ from our usual practice, both in terms of long-term oral anticoagulation and in terms of rhythm control strategy.

Incidence and Predictors of Cardiac Arrhythmias in Patients With COVID-19.

Background: Coronavirus disease 2019 (COVID-19) is a systemic disease caused by severe acute respiratory syndrome coronavirus 2. Arrhythmias are frequently associated with COVID-19 and could be the result of inflammation or hypoxia. This study aimed to define the incidence of arrhythmias in patients with COVID-19 and to correlate arrhythmias with pulmonary damage assessed by computed tomography (CT). Methods: All consecutive patients with a COVID-19 diagnosis hospitalized at Universitair Ziekenhuis Brussel, Belgium, between March 2020 and May 2020, were screened. All included patients underwent a thorax CT scan and a CT severity score, a semiquantitative scoring system of pulmonary damage, was calculated. The primary endpoint was the arrhythmia occurrence during follow-up. Results: In this study, 100 patients were prospectively included. At a mean follow-up of 19.6 months, 25 patients with COVID-19 (25%) experienced 26 arrhythmic episodes, including atrial fibrillation in 17 patients, inappropriate sinus tachycardia in 7 patients, atrial flutter in 1 patient, and third-degree atrioventricular block in 1 patient. No ventricular arrhythmias were documented. Patients with COVID-19 with arrhythmias showed more often need for oxygen, higher oxygen maximum flow, longer QTc at admission, and worse damage at CT severity score. In univariate logistic regression analysis, significant predictors of the primary endpoint were: the need for oxygen therapy (odds ratio [OR] 4.59, 95% CI 1.44-14.67, p = 0.01) and CT severity score of pulmonary damage (OR per 1 point increase 1.25, 95% CI 1.11-1.4, p < 0.001). Conclusions: In a consecutive cohort of patients with COVID-19 the incidence of cardiac arrhythmias was 25%. The need for oxygen therapy and CT severity score were predictors of arrhythmia occurrence during follow-up.

ARRHYTHMIAS INCLUDING ATRIAL FIBRILLATION CLINICAL COURSE AFTER CORONAVIRUS INFECTION

This study aimed to determine how coronavirus infection provoked arrhythmias. Fifteen patients with arrhythmias who had coronavirus infection (group C +) and 10 patients who had the same arrhythmias but did not pass through COVID-19 (group C-) were examined. In most cases, atrial fibrillation or atrial flutter dominated in patients of both examined groups - 86.6 % and 80 % appropriately. Age and overweight are risk factors for arrhythmia onset after coronavirus infection. The frequency of paroxysms increased by 88.9% in patients with AF who underwent coronavirus infection, p<0.005.

Cardiac Arrhythmia Teletriage using Electrocardiogram

Telehealth has become a favorable method for receiving medical care during the COVID-19 pandemic. It reduces physical contact and also benefits those who live a distance from hospitals. In this paper we present a cardiac arrhythmia teletriage using electrocardiogram (ECG). The system consists of a diagnostic algorithm for arrhythmias and an Android application. The diagnostic algorithm can detect five types of cardiac problems-arrhythmia, bradycardia, tachycardia, bradyarrhythmia, and tachyarrhythmia. The Android application is the main communication channel between patients and healthcare providers. The user uploads their ECG and receives a preliminary diagnosis of their heart health via the application. The system notifies the user if it detects any abnormalities. The user can then make an appointment online for further examination at the hospital. The capability of the proposed system is evaluated using four databases from PhysioNet - MITBIH Normal Sinus Rhythm Database, MIT-BIH Arrhythmia Database, MIT-BIH Atrial Fibrillation Database, and CU Ventricular Tachyarrhythmia Database. It is found that the algorithm is able to detect abnormal ECG signals with an average accuracy of 82.1%. © 2021 IEEE.

Randomized Trial of Asprin as Adjuvant Therapy for Node-Positive Breast Cancer

In the United States, more than 3 million women are living after a breast cancer diagnosis. There is great need for additional breast cancer adjuvant treatments that are low-cost and low toxicity. These would not only save thousands of lives, but offer improved quality of life for those who do not tolerate current treatments, and treatment options to women in developing countries who currently get none. We will enroll 3000 women with node-positive HER2 negative Stage II or III breast cancer with a 1:1 randomization to aspirin 325 mg daily versus placebo. Primary endpoint is invasive disease-free survival (including local and distant). Secondary endpoints include recurrence-free interval (local and distant), overall survival, cardiovascular disease, toxicity, and adherence. We will exclude those at high risk of bleeding complications with aspirin (greater than age 70, history of prior stroke, significant gastrointestinal bleeding, anticoagulation) or those with indications for taking aspirin (history of myocardial infarction or atrial fibrillation) Breast cancer advocates will be involved in the creation of all recruitment letters, consent forms, and information sheets. We would conduct the trial in a multi-center collaboration of the Brigham and Womens Hospital, Dana Farber Harvard Cancer Institute, and the Alliance for Clinical Trials in Oncology. The research infrastructure, long-standing leadership roles in clinical trials, and ability to rapidly accrue subjects make the assembled research team ideal to lead a US trial within the proposed time frame.

Effusive pericarditis in the pathogenesis of cardiac arrhythmias in COVID19: a case series

A wide variety of nonpulmonary manifestations of a coronavirus disease 2019 (COVID19) has enriched clinical performance of cardiac diseases with atypical symptoms. Two COVID19 cases are presented, where sinus bradycardia and syncope, which are rare in COVID19, were the leading ones after the infection. The patients had no prior cardiovascular diseases, while the examination did not detected neurological pathology and myocarditis. Echocardiography showed relatively small pericardial effusion, which is supposed to be a cause of the symptoms as the diagnosis to exclude. A local buildup of inflammatory fluid around the sinus node and extensive ganglion plexuses around the atria can possibly affect the automatism and chronotropic compensation in addition to the myocardial inflammation. As part of the treatment against the hydropericardium syndrome, the symptoms disappeared, without reoccurring within subsequent 6month followup. The third clinical case regards the pandemic outbreak, when we could not even suspect that the systemic inflammation would persist for many months after COVID19 and radiofrequency ablation can lead to sudden cardiac death. © 2022 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved.

Hardware-assisted and Deep-Learning techniques for Low-Power Detection of Cardiovascular Abnormalities in Smart Wearables

The COVID-19 pandemic has significantly reduced visits to hospitals and clinics, forcing physicians and clinics to investigate how to move online using telemedicine and home monitoring. Wearable technologies can help by enabling homecare monitoring if they provide accurate and precise measurements. The monitoring of cardiac health problems is such an example and can be managed when patients are residing at home with the use of wearable cardiac monitoring equipment. Recent studies indicate that of various COVID-19 related complications, cardiac abnormalities in particular are associated with a significantly higher mortality rate. It is therefore important to develop smart wearables that are able to analyze and interpret the recorded signal to detect anomalies outside clinical environments where no external devices are available to analyze and store the signals, nor healthcare personnel is present to assist the identification of abnormal heart activity. This paper looks into two different approaches to enable smart wearables to analyze a high-definition electrocardiogram arriving from ECG sensors arrays in order to detect cardiovascular abnormalities. The first approach relies on techniques that enable the execution of deep-learning models within an embedded processor. The second approach uses heterogeneous multicore embedded processors that accelerate the execution of the classifiers. Results indicate the benefits of each approach and the interplay between the performance achieved in terms of event detection ratio and latency of classification. © 2021 IEEE.

Effusive pericarditis in the pathogenesis of cardiac arrhythmias in COVID-19: a case series.

A wide variety of non-pulmonary manifestations of a coronavirus disease 2019 (COVID-19) has enriched clinical performance of cardiac diseases with atypical symptoms. Two COVID-19 cases are presented, where sinus bradycardia and syncope, which are rare in COVID-19, were the leading ones after the infection. The patients had no prior cardiovascular diseases, while the examination did not detected neurological pathology and myocarditis. Echocardiography showed relatively small pericardial effusion, which is supposed to be a cause of the symptoms as the diagnosis to exclude. A local buildup of inflammatory fluid around the sinus node and extensive ganglion plexuses around the atria can possibly affect the automatism and chronotropic compensation in addition to the myocardial inflammation. As part of the treatment against the hydropericardium syndrome, the symptoms disappeared, without reoccurring within subsequent 6-month follow-up. The third clinical case regards the pandemic outbreak, when we could not even suspect that the systemic inflammation would persist for many months after COVID-19 and radiofrequency ablation can lead to sudden cardiac death. (English) [ FROM AUTHOR] Большое многообразие экстрапульмональных проявлений новой коронавирусной инфекции обогатило клинику кардиологических заболеваний нетипичными симптомами. Представлено 2 случая из практики врача ковидного центра, где ведущими являлись редко встречающиеся при COVID-19 (COrona VIrus Disease 2019) синусовая брадикардия и синкопальные состояния в течение месяцев после перенесенной инфекции. У пациентов отсутствовал анамнез сердечно-сосудистых заболеваний, во время исследования не выявлено неврологической патологии и признаков миокардита. По данным эхокардиографии зарегистрирован экссудативный перикардит относительно небольшого объема, который предполагается как причина симптомов в качестве диагноза исключения. Локальное скопление воспалительной жидкости в области синусового узла и богатых ганглионарных сплетений вокруг предсердий, вероятно, негативно влияет на автоматизм и хронотропную компенсацию, в дополнение к воспалению миокарда. На фоне лечения гидроперикарда симптомы купировались и не рецидивировали в течение последующих 6 мес. наблюдения. Третий клинический случай периода начала пандемии, когда еще невозможно было предположить, что системное воспаление персистирует в течение многих месяцев после COVID-19, и радиочастотная аблация воспаленного миокарда может привести к летальному исходу. (Russian) [ FROM AUTHOR] Copyright of Cardiovascular Therapy & Prevention is the property of Silicea-Poligraf LLC and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Sequelae and Comorbidities of COVID-19 Manifestations on the Cardiac and the Vascular Systems.

COVID-19 patients with pre-existing cardiovascular conditions are at greater risk of severe illness due to the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) virus. This review evaluates the highest risk factors for these patients, not limited to pre-existing hypertension, cardiac arrhythmias, hypercoagulation, ischemic heart disease, and a history of underlying heart conditions. SARS-CoV-2 may also precipitate de novo cardiac complications. The interplay between existing cardiac conditions and de novo cardiac complications is the focus of this review. In particular, SARS-CoV-2 patients present with hypercoagulation conditions, cardiac arrhythmias, as significant complications. Also, cardiac arrhythmias are another well-known cardiovascular-related complication seen in COVID-19 infections and merit discussion in this review. Amid the pandemic, myocardial infarction (MI) has been reported to a high degree in SARS-CoV-2 patients. Currently, the specific causative mechanism of the increased incidence of MI is unclear. However, studies suggest several links to high angiotensin-converting enzyme 2 (ACE2) expression in myocardial and endothelial cells, systemic hyper-inflammation, an imbalance between myocardial oxygen supply and demand, and loss of ACE2-mediated cardio-protection. Furthermore, hypertension and SARS-CoV-2 infection patients' prognosis has shown mixed results across current studies. For this reason, an in-depth analysis of the interactions between SARS-CoV2 and the ACE2 cardio-protective mechanism is warranted. Similarly, ACE2 receptors are also expressed in the cerebral cortex tissue, both in neurons and glia. Therefore, it seems very possible for both cardiovascular and cerebrovascular systems to be damaged leading to further dysregulation and increased risk of mortality risk. This review aims to discuss the current literature related to potential complications of COVID-19 infection with hypertension and the vasculature, including the cervical one. Finally, age is a significant prognostic indicator among COVID-19 patients. For a mean age group of 70 years, the main presenting symptoms include fever, shortness of breath, and a persistent cough. Elderly patients with cardiovascular comorbidities, particularly hypertension and diabetes, represent a significant group of critical cases with increased case fatality rates. With the current understanding of COVID-19, it is essential to explore the mechanisms by which SARS-CoV-2 operates to improve clinical outcomes for patients suffering from underlying cardiovascular diseases and reduce the risk of such conditions de novo.

Cardiac Arrhythmias and COVID-19: Correlation With Disease Severity.

Background Cardiac arrhythmia is one of the life-threatening cardiovascular complications commonly reported in patients hospitalized with coronavirus disease 2019 (COVID-19). We aimed to evaluate the association between cardiac arrhythmias and disease severity based on oxygen requirement. Methods In this retrospective observational chart review-based study we recruited 396 patients hospitalized with COVID-19 from March 2020 to May 2020 from two regional medical centers in New Jersey, USA. Patients' baseline characteristics, secondary diagnoses, and laboratory findings were manually extracted and compared among two groups: patients with cardiac arrhythmias and those without. Poisson regression analysis was used to evaluate the correlation of cardiac arrhythmias and increased oxygen requirement, which are: room air (RA), nasal cannula (NC), high flow nasal cannula (HFNC), and bi-level positive airway pressure ventilation or invasive mechanical ventilation (BIPAP/MV). Results The demographic characteristics of the patients were: aged 61 +/- 18.7 years (mean +/- standard deviation); with 56% being male, and 44.9% of African American race. There were 16% patients on RA, 40% on NC, 15% on HFNC, and 29% on BIPAP/MV. The incidence of cardiac arrhythmias was 36.7% (20% pulseless electrical activity (PEA), 13.5% atrial fibrillation (AF). 56% of AF was new-onset arrhythmia. Compared to the RA group, the risk of cardiac arrhythmias was significantly higher in BIPAP/MV (OR 3.3; 95% CI 1.8 - 6.2, p <0.001) and HFNC (OR 2.9; 95% CI 1.5-5.7, p0.001), but not in NC group (OR 0.95; 95% CI 0.4-1.8, p0.89). Compared to patients without arrhythmias, patients with arrhythmias were older (mean age 71 vs. 56 years, p <0.001) and had more comorbidities (Charlson comorbidity index (CCI), 4.7 vs. 2.9, p <0.001). The continued therapy of angiotensin-converting enzyme inhibitors or angiotensin-II receptor blockers did not seem to be associated with increased or decreased risk of cardiac arrhythmias. Conclusion The incidence of cardiac arrhythmias among hospitalized COVID-19 patients was 36.7% with PEA being common in patients who succumbed to death, and AF in those patients who survived. The incidence of cardiac arrhythmias positively correlated with disease severity based on oxygen requirement and was higher among patients requiring HFNC or BIPAP/MV.

COVID-19 and Cardiac Arrhythmias: A Review of the Literature.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of the ongoing coronavirus disease 2019 (COVID-19) pandemic. There are many documented COVID-19-related cardiac complications, one of the most feared is arrhythmia. Many ongoing studies are evaluating the pathophysiology of COVID-19-induced arrhythmia. However, our knowledge about the exact mechanism of the latter is still limited. The underlying possible mechanisms could be related to direct or indirect endomyocardial tissue damage. It is also noted in several studies that cardiac arrhythmias are the consequence of systemic illness, proarrhythmic medications, and electrolytes imbalances in hospitalized patients and not solely the direct effects of COVID-19 infection. In this review article, we present the different aspects of arrhythmias in COVID patients, possible associated conditions, and triggers.

Environmental Fe, Ti, Al, Cu, Hg, Bi, and Si Nanoparticles in the Atrioventricular Conduction Axis and the Associated Ultrastructural Damage in Young Urbanites: Cardiac Arrhythmias Caused by Anthropogenic, Industrial, E-Waste, and Indoor Nanoparticles.

Air pollution exposure is a risk factor for arrhythmia. The atrioventricular (AV) conduction axis is key for the passage of electrical signals to ventricles. We investigated whether environmental nanoparticles (NPs) reach the AV axis and whether they are associated with ultrastructural cell damage. Here, we demonstrate the detection of the shape, size, and composition of NPs by transmission electron microscopy (TEM) and energy-dispersive X-ray spectrometry (EDX) in 10 subjects from Metropolitan Mexico City (MMC) with a mean age of 25.3 ± 5.9 and a 71-year-old subject without cardiac pathology. We found that in every case, Fe, Ti, Al, Hg, Cu, Bi, and/or Si spherical or acicular NPs with a mean size of 36 ± 17 nm were present in the AV axis in situ, freely and as conglomerates, within the mitochondria, sarcomeres, lysosomes, lipofuscin, and/or intercalated disks and gap junctions of Purkinje and transitional cells, telocytes, macrophages, endothelium, and adjacent atrial and ventricular fibers. Erythrocytes were found to transfer NPs to the endothelium. Purkinje fibers with increased lysosomal activity and totally disordered myofilaments and fragmented Z-disks exhibited NP conglomerates in association with gap junctions and intercalated disks. AV conduction axis pathology caused by environmental NPs is a plausible and modifiable risk factor for understanding common arrhythmias and reentrant tachycardia. Anthropogenic, industrial, e-waste, and indoor NPs reach pacemaker regions, thereby increasing potential mechanisms that disrupt the electrical impulse pathways of the heart. The cardiotoxic, oxidative, and abnormal electric performance effects of NPs in pacemaker locations warrant extensive research. Cardiac arrhythmias associated with nanoparticle effects could be preventable.