Persistent Arrhythmogenic Effects of COVID ‐19: A Comprehensive Analysis of Device Implantation and Antiarrhythmic Interventions in Japan

Background The long‐term cardiovascular sequelae of COVID‐19 remain incompletely understood, particularly The risk of arrhythmias and conduction disturbances requiring device Therapy. This nationwide propensity score‐matched cohort study aimed to quantify The two‐year risk of permanent pacemaker (PM), implantable cardioverter‐defibrillator (ICD), and cardiac resynchronization Therapy (CRT) device implantation following COVID‐19 infection. Methods We conducted a nationwide retrospective cohort study using a Japanese administrative claims database. Patients with COVID‐19 were matched 1:1 to individuals without COVID‐19 using propensity scores. The composite outcome was PM, ICD, or CRT implantation. Incidence rates (IRs), incidence rate ratios (IRRs), and incidence rate differences (IRDs) were estimated using Poisson regression models. Subgroup analyses were conducted to assess heterogeneity across covariates. Results A total of 3 077 758 patients with COVID‐19 were propensity score matched with 3 077 758 controls. Over The two‐year follow‐up, The composite endpoint was more frequent in The COVID‐19 group than in controls, with incidence rates of 7.97 and 4.23 per 100 000 person‐months, respectively, corresponding to an incidence rate difference (IRD) of 3.74 per 100 000 person‐months (95% CI, 3.34–4.14) and an incidence rate ratio (IRR) of 1.88 (95% CI, 1.76–2.02). In subgroup analyses, The association was generally consistent across strata, with significant effect modification observed for anticoagulant use and calcium channel blocker use. Conclusions COVID‐19 infection was associated with a sustained increase in The risk of cardiac device implantation, arrhythmia‐related procedures, and initiation of antiarrhythmic medications over a two‐year period. These findings highlight The importance of long‐term cardiovascular monitoring and risk stratification in individuals recovering from COVID‐19.