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PACE - manuscript for review
predictor of mortality highlighting the importance of right heart function and clinical outcomes.25, 26
These findings carry several important implications. This study suggests a potential causal relationship between atrial tachyarrhythmia onset and hemodynamic instability in COVID+ individuals. Importantly, the high mortality associated with ARDS appears to be driven more strongly by hemodynamic instability and degree of shock than by hypoxemia,27 therefore a complication so closely associated with marked hemodynamic deterioration may significantly influence outcomes. Indeed, participants with atrial tachyarrhythmia associated hemodynamic compromise did have worsened survival in our study. We hypothesize that vigilance to optimize factors that may increase the risk of atrial tachyarrhythmia, such as electrolyte imbalances and volume overload, may be beneficial not only for heart rhythm, but also for blood pressure stability and downstream outcomes including survival. Although these findings may suggest that less hemodynamically impactful ventilatory strategies, such as a low PEEP strategy, could improve hemodynamic stability in COVID+ individuals or ARDS individuals with atrial tachyarrhythmia, this study does not directly address this question. It is conceivable that increased attention to a rhythm control strategy in COVID-19 individuals may have greater benefit than that seen in general critical illness, and prospective studies of this question may be justified. As our COVID-comparative cohort did not have a high incidence of ARDS, it is unclear if the observed