Cardiac Dysrhythmia in COVID-19 Patients; Occurrence and Risk Factors: a Retrospective Cohort Study

Objective: In this study, we have evaluated the occurrence and risk factors of cardiac dysrhythmia on admission and during hospitalization in COVID-19 patients. Methods: This study was conducted as a retrospective cohort in which 893 electrocardiograms (ECGs) taken at the time of admission, and 328 ECGs taken during hospitalization were evaluated. These ECGs were assessed for cardiac dysrhythmias by a cardiologist. Finally, relationships between clinical characteristics and the occurrence of cardiac dysrhythmias in patients were assessed. Results: Most common cardiac dysrhythmias on admission were sinus tachycardia (64.8%), atrial fibrillation (13.5%), and sinus bradycardia (11.3%). Multivariate regression analysis showed that a history of metformin use (RR=0.83; P=0.042) was independently associated with reduced risk of cardiac dysrhythmias on admission, while male sex (RR=1.16; P=0.018), history of cardiovascular diseases (RR=1.16; P=0.017), history of cancer (RR=1.40; P=0.004) and QT interval prolongation on ECG (RR=1.18; P=0.017) were associated with a higher risk of cardiac dysrhythmias on admission. Also, among the 328 patients that had a second ECG, 185 (56.4%) experienced cardiac dysrhythmias during their hospitalization. Multivariate analysis showed that presence of cardiac dysrhythmias on admission (RR=1.85; 95% CI: 1.49,2.35; P<0.001) was the only independent prognostic factor for the occurrence of cardiac dysrhythmias during hospitalization. No significant relationships were observed between treatment regimens and the incidence of cardiac dysrhythmias. Conclusion: The present study showed that more than half of COVID-19 patients have cardiac dysrhythmias on admission. Our analyses illustrated that a history of metformin use was associated with a lower risk of cardiac dysrhythmias on admission, while male sex, history of cardiovascular diseases, history of cancer, and QT interval prolongation were associated with a higher rate of cardiac dysrhythmias. Hydroxychloroquine use along with azithromycin and kaletra (lopinavir-ritonavir) had no association with the development of cardiac dysrhythmias during hospitalization.