Background: Coronavirus Disease 2019 (COVID-19) is associated with many
clinical manifestations including respiratory failure and cardiovascular
compromise. Objectives: We examine outcomes in critically ill
individuals with COVID-19 who develop atrial tachyarrhythmias (ATA).
Methods: We collected data from electrocardiograms and the electronic
medical record of COVID-19 positive (COVID+) and negative (COVID-)
individuals admitted to our medical intensive care unit between February
29 and June 28, 2020. We compared clinical and demographic
characteristics, new onset ATA, hemodynamic compromise (HC) following
ATA, and in-hospital mortality in those who were COVID+ vs. COVID-. HC
was defined as having a new or increased vasopressor requirement or the
need for direct current cardioversion for hemodynamic instability within
1 hour of ATA onset. Results: Of 300 individuals included, 200 were
COVID+ and 100 were COVID-. Mean age was 60±16 years, 180 (60%) were
males, and 170 (57%) were African American. New onset ATA occurred in
16% of COVID+ and 19% of COVID- individuals (p=0.51). When compared to
COVID- participants without ATA, COVID+ individuals with new onset ATA
had higher mortality after multivariable adjustment (OR 5.0, 95% CI
1.9-13.5). New onset ATA was followed by HC in 18 COVID+ but no COVID-
participants (P=0.0001). COVID+ individuals with HC after ATA were
requiring high levels of ventilatory support at the time of ATA onset.
Conclusions: ATA may be an important mediator of HC in critically ill
individuals with COVID-19, especially for those mechanically ventilated.
Recognition of this could assist with clinical care and prognostication
for individuals with COVID-19.