Arrhythmias and electrocardiographic findings in Coronavirus disease 2019: A systematic review and meta‐analysis

• Published in: Pacing and Clinical Electrophysiology Vol. 44; no. 6; pp. 1062 - 1074
• Main Authors: Garcia‐Zamora, Sebastian, Lee, Sharen, Haseeb, Sohaib, Bazoukis, George, Tse, Gary, Alvarez‐Garcia, Jesus, Gul, Enes Elvin, Çinier, Göksel, Alexander, Bryce, Martins Pinto‐Filho, Marcelo, Liu, Tong, Baranchuk, Adrian
• Format: Journal Article Web Resource
• Language: English
• Published: United States John Wiley & Sons, Inc 01.06.2021; Wiley Subscription Services, Inc; John Wiley and Sons Inc
• Subjects: Arrhythmia; atrial fibrillation; Bronchopulmonary infection; Cardiac arrhythmia; Coronaviruses; COVID-19; ECG; EKG; Electrophysiology; Heart; Meta-analysis; Prognosis; Systematic review; Ventricle; ventricular tachyarrhythmias; COVID-19; ECG; atrial fibrillation; ventricular tachyarrhythmias
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/pace.14247

Background Coronavirus disease 2019 (COVID‐19) primarily causes lung infection, but recent studies have shown that cardiac involvement is associated with a worse prognosis. Objectives We conducted a systematic review and meta‐analysis to examine the prevalence of cardiac arrhythmias detected by the electrocardiogram and their relationships with adverse outcomes in patients with COVID‐19. Methods PubMed and Google were searched for studies that reported on cardiac arrhythmias and/or examined the relationship between arrhythmias and adverse outcomes. Results Thirty studies with 12,713 participants were included in the systematic review, and 28 studies (n = 12,499) in the meta‐analysis. The mean age was 61.3 ± 16.8 years; 39.3% were female. In 25 studies with 7578 patients, the overall prevalence of cardiac arrhythmias was 10.3% (95% confidence interval [CI]: 8.4%–12.3%). The most common arrhythmias documented during hospitalization were supraventricular arrhythmias (6.2%, 95% CI: 4.4%–8.1%) followed by ventricular arrhythmias (2.5%, 95% CI: 1.8%–3.1%). The incidence of cardiac arrhythmias was higher among critically ill patients (relative risk [RR]: 12.1, 95% CI: 8.5–17.3) and among non‐survivors (RR: 3.8, 95%, CI: 1.7–8.7). Eight studies reported changes in the QT interval. The prevalence of QTc > 500 ms was 12.3% (95% CI: 6.9%–17.8%). ST‐segment deviation was reported in eight studies, with a pooled estimate of 8.7% (95% CI: 7.3% to 10.0%). Conclusion Our meta‐analysis showed that QTc prolongation, ST‐segment deviation, and various other cardiac arrhythmias were observed in patients hospitalized with COVID‐19. The presence of cardiac arrhythmias was associated with a worse prognosis.