Study outcomes
The study primary outcome was any arrhythmia documented during the
hospitalization. The search for arrhythmias was based on review of all
patients’ medical records, 12-lead ECG’s, 24-hour Holters or continuous
ECG monitoring (telemetry).
Our secondary aim was to evaluate possible predictors for arrhythmia
occurrence, with regard to:
- Patients’ medical history; including age, gender, hypertension (HTN),
diabetes mellitus (DM), ischemic heart disease (IHD), background
congestive heart failure (CHF), and previous documented arrhythmia
- Presenting ”arrhythmic” symptom as palpitations or syncope
- Disease severity. Disease severity was categorized primarily according
to the patients’ respiratory status, and categorized as mild for those
who did not need any O2 support during their
hospitalization; moderate for those who required some
O2 support via nasal cannula or mask; severe for those
who required non-invasive ventilation (high-flow, CPAP, etc); and
critical for those who needed mechanical ventilation or alternatively
those with multi-organ failure who were supported by inotropes.
Notably, disease severity was determined according to the patients’
worst respiratory or hemodynamic status during their hospitalization
period.
- Presence of cardiac injury as assessed by high-sensitive cardiac
troponin-I (hsTnI) and/or Trans Thoracic Echocardiography (TTE).
- Inflammatory status based on D-DIMER and CRP lab measurements
- QTc duration, as evidenced by review of all patients ECG’s performed
during the hospitalization period, determining the ECG with longest
QTc duration. Notably, to look for other potential contributors for
prolonged QTc we documented the patient’s electrolytes and medications
around the day of longest QTc ECG. The QTc was calculated using the
Bazett formula. In patients with heart rate of less than 60 QT and not
QTc was measured.
- COVID-19 treatments, especially regarding use of Hydroxychloroquine
and Azithromycin and other QT-prolonging medications