Outcomes of COVID-19 with Concomitant and New-Onset Atrial Arrhythmias: Propensity Matched Analysis of Large Cohort

Background: Atrial arrythmias have been frequently noted in patients with COVID-19, with high prevalence in those requiring mechanical ventilation. The clinical implications of pre-existing atrial arrythmias, or such ‘COVID-associated’ atrial arrythmias is yet to be studied.Objective: To report clinical outcomes of COVID-19 infection in patients with pre-existing and new-onset Atrial arrythmias, and compare these outcomes with patients without Atrial arrythmias.Methods: Analysis of a large multicenter research network TriNETX was performed including patients more than 16 years of age diagnosed with COVID-19. Outcomes of COVID-19 in patients with Atrial fibrillation or flutter were compared to those without a history of these arrythmias. Propensity score matching was performed to control for known risk factors of severe COVID-19.Results: A total of 394,338 patients with COVID-19 were included, of which 19,405 patients (4.92%) carried a diagnosis of Atrial fibrillation/flutter. These were further classified into pre-existing Atrial fibrillation/flutter (n=14,973), pre-existing Atrial fibrillation (n=14,494), new-onset Atrial fibrillation/flutter (n=3,812) and new-onset Atrial fibrillation (n=3,521) for sub-group analysis. Patients with Atrial fibrillation/flutter had increased risk of mortality, hospitalization, critical care need, and mechanical ventilation when compared to the control group. New-onset atrial fibrillation/flutter was associated with even worse outcomes, with a 20-fold and 4-fold higher risk of mortality than control group at 30 days in unmatched and matched analyses respectively. Conclusion: Patients with pre-existing or new onset Atrial fibrillation/flutter are at risk of poor outcomes with COVID-19. Further, new-onset atrial fibrillation portends markedly worse outcomes in COVID-19 disease.