Severe COVID patients 16 times more likely to experience V-tach

Patients with severe COVID-19 requiring mechanical ventilation are 16 times more likely to develop ventricular tachycardia (V-tach) within 6 months following discharge compared with matched controls without severe infection in a Swedish case-control study presented at EHRA 2023.

Risks of other arrhythmic events also increased in this patient cohort.

“The actual likelihood of developing ventricular tachycardia or other arrhythmias after severe COVID-19 is low for the individual patient but is much higher than in those without severe infection,” reported study author Dr Andreas Liliequist from the Karolinska Institute in Stockholm, Sweden. [EHRA 2023, ePoster session 49]

The long-term risk of de novo arrhythmic events after severe COVID-19 requiring intensive care is largely unknown, particularly after adjusting for multiple risk factors such as comorbidities and socio-economic factors.

Liliequist and colleagues assessed the long-term risk of arrhythmic events among 3,023 patients with severe COVID-19 treated with mechanical ventilation and discharged from an intensive care unit in Sweden between March 2020 and June 2021 and 28,463 non-severely ill controls. The average age of the patients was 62 years and 70 percent were men. The average follow-up was 12 months.

Patients were individually matched by age, sex, and district of residence with up to 10 people in the general population. Multiple compulsory national registries were used to record new diagnoses of arrhythmias after ICU discharge.

 Primary endpoint

The primary outcome was hospitalization with ventricular tachycardia, atrial fibrillation, other tachyarrhythmias, or bradycardia/pacemaker implantation.

Ventricular tachycardia is a potentially life-threatening heart rhythm disturbance that occurs when the ventricle beats too fast that the heart cannot pump enough blood to the body.

In atrial fibrillation, faulty electrical signals make the atria contract irregularly and much faster than normal, making it out of sync with the ventricles. Blood can pool in the atrium which can lead to blood clots and strokes. 

Other tachyarrhythmias refer to a fast heartbeat not caused by atrial fibrillation whereas bradycardia or pacemaker implantation is a combined endpoint of slow heart rate or need for a pacemaker due to slow heart rate.

In patients who had severe COVID-19, the incidence rates per 1,000 person-years of ventricular tachycardia, atrial fibrillation, other tachyarrhythmias, and bradycardia/pacemaker implantation were 15.4, 78.4, 99.3, and 8.5, respectively, said Liliequist. In the control group, the corresponding incidence rates were 0.9, 6.0, 6.7, and 0.9, respectively.

What the study tells us

The hazard ratios for the risk of de novo arrhythmic event post-ICU discharge for  COVID-19 (adjusted for age, gender, all comorbidities, education level), marital status, and income were increased between 13.1–21.0 in all four types of arrhythmias. Compared with the control group, those who had severe COVID-19 requiring mechanical ventilation had a 16-fold risk of ventricular tachycardia, a 13-fold risk of atrial fibrillation, a 14-fold risk of other tachyarrhythmias, and a 9-fold risk of bradycardia/pacemaker implantation.

“Having a heart rhythm disorder in COVID-19 patients who need mechanical ventilation may lead to worsened health,” Liliequist said. “COVID patients with risk factors for arrhythmias should be closely followed-up after discharge.”