Worldwide Survey of COVID-19-Associated Arrhythmias

Ellie J. Coromilas, Stephanie Kochav, Isaac Goldenthal, Angelo Biviano, Hasan Garan, Seth Goldbarg, Joon Hyuk Kim, Ilhwan Yeo, Cynthia Tracy, Shant Ayanian, Joseph Akar, Avinainder Singh, Shashank Jain, Leandro Zimerman, Maurício Pimentel, Stefan Osswald, Raphael Twerenbold, Nicolas Schaerli, Lia Crotti, Daniele FabbriGianfranco Parati, Yi Li, Felipe Atienza, Eduardo Zatarain, Gary Tse, Keith Sai Kit Leung, Milton E. Guevara-Valdivia, Carlos A. Rivera-Santiago, Kyoko Soejima, Paolo De Filippo, Paola Ferrari, Giovanni Malanchini, Prapa Kanagaratnam, Saud Khawaja, Ghada W. Mikhail, Mauricio Scanavacca, Ludhmila Abrahão Hajjar, Brenno Rizerio, Luciana Sacilotto, Reza Mollazadeh, Masoud Eslami, Vahideh Laleh Far, Anna Vittoria Mattioli, Giuseppe Boriani, Federico Migliore, Alberto Cipriani, Filippo Donato, Paolo Compagnucci, Michela Casella, Antonio Dello Russo, James Coromilas, Andrew Aboyme, Connor Galen O'Brien, Fatima Rodriguez, Paul J. Wang, Aditi Naniwadekar, Melissa Moey, Chia Siang Kow, Wee Kooi Cheah, Angelo Auricchio, Giulio Conte, Jongmin Hwang, Seongwook Han, Pietro Enea Lazzerini, Federico Franchi, Amato Santoro, Pier Leopoldo Capecchi, Jose A. Joglar, Anna G. Rosenblatt, Marco Zardini, Serena Bricoli, Rosario Bonura, Julio Echarte-Morales, Tomás Benito-González, Carlos Minguito-Carazo, Felipe Fernández-Vázquez, Elaine Y. Wan

Research output: Contribution to journalArticlepeer-review

123 Scopus citations


Background: Coronavirus disease 2019 (COVID-19) has led to over 1 million deaths worldwide and has been associated with cardiac complications including cardiac arrhythmias. The incidence and pathophysiology of these manifestations remain elusive. In this worldwide survey of patients hospitalized with COVID-19 who developed cardiac arrhythmias, we describe clinical characteristics associated with various arrhythmias, as well as global differences in modulations of routine electrophysiology practice during the pandemic. Methods: We conducted a retrospective analysis of patients hospitalized with COVID-19 infection worldwide with and without incident cardiac arrhythmias. Patients with documented atrial fibrillation, atrial flutter, supraventricular tachycardia, nonsustained or sustained ventricular tachycardia, ventricular fibrillation, atrioventricular block, or marked sinus bradycardia (heart rate<40 bpm) were classified as having arrhythmia. Deidentified data was provided by each institution and analyzed. Results: Data were collected for 4526 patients across 4 continents and 12 countries, 827 of whom had an arrhythmia. Cardiac comorbidities were common in patients with arrhythmia: 69% had hypertension, 42% diabetes, 30% had heart failure, and 24% had coronary artery disease. Most had no prior history of arrhythmia. Of those who did develop an arrhythmia, the majority (81.8%) developed atrial arrhythmias, 20.7% developed ventricular arrhythmias, and 22.6% had bradyarrhythmia. Regional differences suggested a lower incidence of atrial fibrillation in Asia compared with other continents (34% versus 63%). Most patients in North America and Europe received hydroxychloroquine, although the frequency of hydroxychloroquine therapy was constant across arrhythmia types. Forty-three percent of patients who developed arrhythmia were mechanically ventilated and 51% survived to hospital discharge. Many institutions reported drastic decreases in electrophysiology procedures performed. Conclusions: Cardiac arrhythmias are common and associated with high morbidity and mortality among patients hospitalized with COVID-19 infection. There were significant regional variations in the types of arrhythmias and treatment approaches.

Original languageEnglish (US)
Pages (from-to)E009458
JournalCirculation: Arrhythmia and Electrophysiology
Issue number3
StatePublished - Mar 1 2021


  • COVID-19
  • arrhythmia
  • atrial fibrillation
  • atrial flutter
  • bradycardia
  • tachycardia
  • torsade de pointes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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