key: cord-0899925-5iy35thc authors: Mohammadyari, Elham; Ahmadi, Iraj; Mohammadyari, Anis; Tavan, Hamed; Norozi, Siros title: The frequency of arrhythmias in COVID-19 patients, a study in the Shahid Mostafa Khomeini Hospital of Ilam from March to August 2020 date: 2021-03-19 journal: New Microbes New Infect DOI: 10.1016/j.nmni.2021.100867 sha: 45aa028fe2935db7d170c1f122ad743bfe8d3cfc doc_id: 899925 cord_uid: 5iy35thc Introduction Cardiac arrhythmias are important causes of death among populations and always responsible for a high percentage of mortality in hospitalized patients. The aim of this study was to evaluate the frequency of arrhythmias in COVID-19 patients in the Shahid Mostafa Khomeini Hospital of Ilam from March to August 2020. Materials and Methods In this descriptive-analytical study, all the COVID-19 patients with a cardiac condition admitted to the intensive care unit were enrolled by census. Electrocardiography (ECG) and Holter monitoring were used to diagnose arrhythmias. Data analysis was performed in Microsoft Excel using descriptive statistics (frequency and percentage). Results The total number of eligible patients was 45, of whom 26 (57.8%) were men, and 19 (42.2%) were women. The mortality rate of arrhythmias among COVID-19 patients was 17.77% (8 out of 45 patients), and the recovery rate was 82.13% (37 out of 45 patients). Conclusion Tachycardia and the lack of response to heart rate reducing drug be observed in patients with COVID-19.Owing to an overlap between these symptoms and those of heart diseases, there is a need to further evaluate patients with arrhythmias. Although arrhythmias are not common in COVID-19 patients, they can be fatal and inflict a high mortality rate, which can be prevented by early detection. COVID-19 has turned into a global problem since recent months with spreading to more than 150 countries around the globe and transforming to a pandemic (1) . In a study by Ruanet al, they showed that the mortality rate ofCOVID-19 significantly increased in the presence of cardiovascular abnormalities (2) . Another study noted that underlying diseases such as hypertension can increase the mortality rate up to 2.5 times (3) . Although the clinical manifestations of COVID-19 in patients with cardiac failure are unknown, the clinical features of patients with end-stage heart disease indicate cardiac injury by the virus (4) (5) (6) . COVID-19 manifestations also linked with demographic parameters. The highest mortality is related to older men with a mean age of 75 years, who also present histories of underlying conditions such as diabetes, hypertension, heart problems, chronic respiratory disease, cancer, and prior surgery. COVID-19 exaggerates cardiovascular complications by promoting arterial and venous thrombosis through inducing inflammation, activating platelets, and causing vascular dysfunction and blockade. Because of this, antithrombotic drugs are recommended to be prescribed in these patients (7) . In addition to promoting inflammatory responses and myocardial injury, COVID-19 also augments the risk of acute coronary artery syndrome, HF, and arrhythmias (8) . Cardiac arrhythmias are the most threatening complications of heart diseases and cause the death of a large number of patients. The aim of this study was to investigate the frequency of arrhythmias in patients with COVID-19 in the Shahid Mostafa Khomeini Hospital of Ilam from March to August 2020. In this descriptive-analytical study, all patients with COVID-19 and a cardiac condition admitted to the intensive care unit during March to August 2020were enrolled by census. A definite diagnosis of COVID-19 by PCR was applied as an inclusion criterion. Electrocardiography (ECG) and Holter monitoring were used to diagnose cardiac status. Data analysis was performed in Microsoft Excel applying descriptive statistics (frequency and percentage). In total, 45 eligible patients were enrolled, of whom 26 (57.8%) were men, and 19 (42.2%)were women. Twelve people (26.7%) had an age under 60 years old, 23 (51.1%) were between 60 and 70 years old, and 10 (22.3%) were over 70 years old. Of these patients, 40 (88.9%) had a history of hospitalization prior to admission. The criterionfor being hospitalized was a positive PCR test. After the diagnosis of Covid-19 based on clinical symptoms, treatment and supportive care were started, and after confirmation by PCR (which generally takes around 48 to 72 hours), the patient was subjected to major therapeutic measures. The medications used for these patients included Ciprofloxacin, Vancomycin, Ceftriaxone, Dexamethasone, Recigen, and Remdesivir, according to clinical signs and symptoms. The genotype of SARS-CoV-2 in this period was D614G. Table 1 demonstrates the frequencies of different types of arrhythmias and non-arrhythmias observed in ECG. Figure 1 shows the frequencies of AF and PVC arrhythmias in each gender. The fatality rate of arrhythmias among COVID-19 patients was 17.77% (8 out of 45 patients of whom6 (13.33%) were males, and 2 (4.44%) were females).The recovery rate was obtained 82.13% (37 out of 45), of whom 20 (46.44%) were men, and 17 (37.77%) were women. From deceased patients, each of AF, VT, and VF was detected in two patients. Holter monitoring was performed to verify arrhythmia in 3 patients, of whom; one was diagnosed with VT, and the other two with sinus tachycardia. Table 2 shows the frequency of death in COVID-19 patients with arrhythmia and non-arrhythmia disorders. Figure 1 shows the prevalence of AF and PVC arrhythmias in each gender. J o u r n a l P r e -p r o o f between the SARS-CoV infection and inflammatory mediators that may play important roles in the path physiology of cardiac events and arrhythmias. In one study, the rate of heart damage was 1% in around 19% of the patients diagnosed with COVID-19, and this event was associated with a higher risk of in-hospital mortality (9) . The mortality rate of arrhythmias in COVID-19 patients was 17.77%, and the recovery rate was 82.13%. Although acute lung injury is a common problem in patients with COVID-19, which leads to significant morbidity and mortality, clinical and epidemiological evidences suggest that COVID-19 infection is also associated with myocardial damage and arrhythmias (2) . According to Mandipet al. studying cardiovascular risk factors in patients with heart conditions, 30.5%, 26.3%, 14.3%, 16.8%, and 5.5% of the patients reported hyperlipidemia, hypertension, diabetes, a history of smoking, and current smoking, respectively. In the recent study, J o u r n a l P r e -p r o o f cardiovascular diseases included coronary artery disease (11.3%), congestive heart failure (2.1%), and cardiac arrhythmia (3.4%). The patients' average length of hospital stay was between 8 and 12 days, and the overall in-hospital mortality rates were 5.8% in total (515 out of 8910 patients) and 24.7% in the patients hospitalized in the intensive care unit (2) . The most common arrhythmias in the deceased patients were AF, VF, and VT, respectively. This was in line with the study of Pitroet al. who asserted that the virus-induced aberrant function of the immune system increased the risk of arrhythmic events, including severe ventricular arrhythmias (11). We noticed that the mortality rate was higher among men than women. Along with age and gender, many other complications and parameters have been associated with severity and mortality rate in COVID-19 and SARS infections. Nevertheless, age was comparable between men and women in our study. However, the disease was more severe in men than women. Despite a similar distribution in men and women, the number of men who died of COVID-19 was 2.4 times higher than women. Regardless of age, men with COVID-19 infection have been at a higher risk for severe consequences and death (12). Tachycardia and failure to respond to heart rate reducing drug may be features of COVID-19 patients. These can overlap with the symptoms of heart diseases, and therefore, there is a need for further investigation of a possible COVID-19 infection in patients with arrhythmic symptoms. The low power of the study was one of our limitations, which was due to the relatively small number of COVID-19 patients in the province. Although arrhythmias are not common in COVID-19 patients, they have a high mortality rate, necessitating early diagnostic and therapeutic interventions. It is recommended to screen cardiac abnormalities inCOVID-19 patients, which can affect their prognosis and survival by early diagnosis of arrhythmias. Hydroxychloroquine for treatment of SARS-CoV-2 infection? Improving our confidence in a model-based approach to dose selection Correction to: Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China Hypertension and its severity or mortality in Coronavirus Disease 2019 (COVID-19): a pooled analysis End-stage Heart Failure with COVID-19: Strong Evidence of Myocardial Injury by COVID-19 in patients with cardiovasculardiseases COVID-19 and thrombotic or thromboembolic disease: Implications for prevention, antithrombotic therapy, and follow-up Impact of coronavirus disease 2019 (COVID-19) outbreak on ST-segment-elevation myocardial infarction care in Hong Kong Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in wuhan Gender Differences in Patients With COVID-19: Focus on Severity and Mortality The authors declare no conflicts of interest.