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Cardiac arrhythmias among hospitalized Coronavirus 2019 (COVID-19) patients: prevalence, characterization, and clinical algorithm to classify arrhythmic risk
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  • Moshe Rav Acha,
  • Amir Orlev,
  • Itay Itzhaki,
  • Frederic S Zimmerman,
  • Bashar Fteiha,
  • Davina Bohm,
  • Ramzi Kurd,
  • Tal Y Samuel,
  • Elad Asher,
  • Yigal Helviz,
  • Michael Glikson,
  • Yoav Michowitz
Moshe Rav Acha
Shaare Zedek Medical Center
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Amir Orlev
Shaare Zedek Medical Center
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Itay Itzhaki
Hebrew University Hadassah Medical School
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Frederic S Zimmerman
Shaare Zedek Medical Center
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Bashar Fteiha
Shaare Zedek Medical Center
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Davina Bohm
Shaare Zedek Medical Center
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Ramzi Kurd
Shaare Zedek Medical Center
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Tal Y Samuel
Shaare Zedek Medical Center
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Elad Asher
Shaare Zedek Medical Center
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Yigal Helviz
Shaare Zedek Medical Center
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Michael Glikson
Shaare Zedek Medical Center
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Yoav Michowitz
Shaare Zedek Medical Center
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Abstract

Objectives: A significant proportion of COVID-19 patients may have cardiac involvement including arrhythmias. Although arrhythmia characterization and possible predictors were previously reported, there are conflicting data regarding the exact prevalence of arrhythmias. Clinically applicable algorithms to classify COVID patients’ arrhythmic risk are still lacking, and are the aim of our study. Methods: We describe a single center cohort of hospitalized patients with a positive nasopharyngeal swab for COVID-19 during the initial Israeli outbreak between 1/2/2020 –30/5/2020. The study’s outcome was any documented arrhythmia during hospitalization, based on daily physical examination, routine ECG’s, periodic 24-hour Holter, and continuous monitoring. Multivariate analysis was used to find predictors for new arrhythmias and create classification trees for discriminating patients with high and low arrhythmic risk. Results: Out of 390 COVID-19 patients included, 28 (7.2%) had documented arrhythmias during hospitalization, including: 23 atrial tachyarrhythmias, combined atrial fibrillation (AF) and ventricular fibrillation, ventricular tachycardia storm, and 3 bradyarrhythmias. Only 7/28 patients had previous arrhythmias. Our study showed significant correlation between disease severity and arrhythmia prevalence (p<0.001) with a low arrhythmic prevalence among mild disease patients (2%). Multivariate analysis revealed background heart failure (CHF) and disease severity are independently associated with overall arrhythmia while age, CHF, disease severity, and arrhythmic symptoms are associated with tachyarrhythmias. A novel decision tree using age, disease severity, CHF, and troponin levels was created to stratify patients into high and low risk for developing arrhythmia. Conclusions: Dominant arrhythmia among COVID-19 patients is AF. Arrhythmia prevalence is dependent on age, disease severity, CHF, and troponin levels. A novel simple Classification tree, based on these parameters, can discriminate between high and low arrhythmic risk patients.

Peer review status:ACCEPTED

18 Sep 2020Submitted to International Journal of Clinical Practice
21 Sep 2020Submission Checks Completed
21 Sep 2020Assigned to Editor
22 Sep 2020Reviewer(s) Assigned
29 Sep 2020Review(s) Completed, Editorial Evaluation Pending
08 Oct 20201st Revision Received
12 Oct 2020Submission Checks Completed
12 Oct 2020Assigned to Editor
12 Oct 2020Reviewer(s) Assigned
15 Oct 2020Review(s) Completed, Editorial Evaluation Pending
21 Oct 2020Editorial Decision: Accept