Potential Mechanisms for New Onset Atrial Fibrillation in COVID-19 Patients

Introduction: This study shows the prevalence of New-Onset Atrial Fibrillation in COVID-19 patients and highlights the most prevalent explanatory pathologic theories for the correlation. Methods: The authors carried out a literature review over PubMed using the keywords “atrial fibrillation” and “long-term COVID.” 48 articles were reviewed. Articles relating to new onset of atrial fibrillation in COVID-19 patients were included while articles posted before 2020, not related to COVID and atrial fibrillation were excluded. Results: The prevalence of atrial fibrillation in COVID patients is often reported to be around 17%, however 44% of patients within Intensive Care units (ICU) have atrial fibrillation with COVID. COVID-19 is proposed to lead to development of atrial fibrillation through dysregulation of the ACE2 receptor, increase in T-cell activation, and increasing the thrombocytes within the heart. Leading to increased edema and blockage of the electrophysiology of the heart. Discussions: Atrial fibrillation constitutes a significant risk factor for patients hospitalized for COVID-19, especially in severe cases like in the ICU. This finding resembles similar arrhythmias found in other viruses like Middle East respiratory syndrome (MERS). The prevalence of arrhythmias with viral infections shows the need to monitor the cardiac rhythms of patients with viral infections. Conclusions: COVID-19 poses a significant risk of leading to atrial fibrillation in severe cases. However, the pathophysiology has not been confirmed. Future work needs to confirm the pathophysiology of COVID-19 and atrial fibrillation to establish better treatments for patients and show the need to monitor patients’ hospitalized for viral infection cardiac rhythm.