Introduction
During the last year the world has faced a new Corona virus pandemic,
named COVID-19. Although COVID-19 clinical manifestations are mainly
respiratory, cardiac involvement exists in a substantial number of
patients, and cardiac arrhythmias have been reported in variable percent
of patients, ranging from 6% to 19% of overall hospitalized COVID
patients and from 9% to 44% of COVID patients hospitalized in
intensive care units (ICU).1,2,3 In some patients,
arrhythmias represent the first clinical manifestation of COVID
infection,4,5 while in others arrhythmia may occur
only during the recovery out-of-hospital period.6Overall, there seems to be a correlation between disease severity in
general and cardiac involvement specifically to occurrence of cardiac
arrhythmias,2,4,6 although sudden cardiac death was
described among mild COVID-19 patients as well.4Moreover, a significant minority of severe COVID ICU patients with
arrhythmias had normal troponin levels, suggesting other mechanisms
rather than cardiac injury, triggering arrhythmias in these
patients.3,7 Various potential causes for cardiac
involvement and arrhythmias were suggested, including: a) direct viral
myocardial injury- myocarditis,2,4,6 b)
cytokine-induced myocardial injury as well as cytokine-mediated
conduction disturbances8,9 and QT
prolongation;3 c) hypoxemia, d) hypotension, e)
hyper-adrenergic state, f) drug effect, such as hydroxychloroquine or
azithromycin , which can lead to prolonged QT-related Torsades de
Pointes as well as to nodal and infra-nodal conduction
disturbances.4,10,11 Although much data has
accumulated regarding various cardiac complications in COVID-19, the
characterization and exact prevalence of cardiac arrhythmias among
COVID-19 patients and more so among the mild-moderate ones is still
unclear.4,6 Furthermore, although various possible
predictors for cardiac arrhythmias in COVID patients were
speculated,2,4,6,7,9 a simple clinical algorithm to
classify arrhythmic risk has not been developed so far. Such algorithm
is critical to guide cardiac monitoring level during the hospitalization
period and maybe during the recovery period as well. The primary aim of
our study was to characterize the various arrhythmias encountered among
hospitalized COVID-19 patients of various severity levels, describe
their prevalence and develop a clinical algorithm to classify arrhythmic
risk.