Key result
The first 100 days of the COVID-19 pandemic were associated with a 33% increase in atrial fibrillation episodes among patients with CIEDs compared to 2019 (IRR 1.33; 95% CI 1.25-1.40; P<0.001).
Why the study?
The association between the COVID-19 pandemic and AF occurrence in individuals with CIEDs had not been determined.
Does the COVID-19 pandemic increase atrial fibrillation burden in patients with cardiac implantable electronic devices?
Cohort (n=10,346)
Yes
Does the COVID-19 pandemic increase atrial fibrillation burden in patients with cardiac implantable electronic devices?
Relative Risk: 1.33 (95% CI 1.25–1.4)
p-value: p=< 0.001
The COVID-19 pandemic was associated with a 33% increase in atrial fibrillation episodes among patients with cardiac implantable electronic devices, suggesting an impact of pandemic-associated social disruptions.
Pandemic disruptions were associated with higher AF burden in CIED patients; leaves open causal pathways and need for prospective confirmation.
AIMS: The aim of this study is to determine the association between the coronavirus disease 2019 (COVID-19) pandemic and atrial fibrillation (AF) occurrence in individuals with cardiac implantable electronic devices (CIEDs). METHOD AND RESULTS: Multi-centre, observational, cohort study over a 100-day period during the COVID-19 pandemic (COVID-19) in the USA. Remote monitoring was used to assess AF episodes in patients with a CIED (pacemaker or defibrillator; 20 centres, 13 states). For comparison, the identical 100-day period in 2019 was used (Control). The primary outcomes were the AF burden during the COVID-19 pandemic, and the association of the pandemic with AF occurrence, as compared with 1 year prior. The secondary outcome was the association of AF occurrence with per-state COVID-19 prevalence. During COVID-19, 10 346 CIEDs with an atrial lead were monitored. There were 16 570 AF episodes of ≥6 min transmitted (16 events per 1000 patient days) with a significant increase in proportion of patients with AF episodes in high COVID-19 prevalence states compared with low prevalence states [odds ratio 1.34, 95% confidence interval (CI) 1.21-1.48, P < 0.001]. There were significantly more AF episodes during COVID-19 compared with Control [incident rate ratio (IRR) 1.33, 95% CI 1.25-1.40, P < 0.001]. This relationship persisted for AF episodes ≥1 h (IRR 1.65, 95% CI 1.53-1.79, P < 0.001) and ≥6 h (IRR 1.54, 95% CI 1.38-1.73, P < 0.001). CONCLUSION: During the first 100 days of COVID-19, a 33% increase in AF episodes occurred with a 34% increase in the proportion of patients with AF episodes observed in states with higher COVID-19 prevalence. These findings suggest a possible association between pandemic-associated social disruptions and AF in patients with CIEDs. CLINICAL TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry: ACTRN12620000692932.
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O’Shea et al. (2021) conducted a cohort in Atrial fibrillation in individuals with cardiac implantable electronic devices (n=10,346). COVID-19 pandemic period vs. Identical 100-day period in 2019 was evaluated on Atrial fibrillation burden and association of the pandemic with atrial fibrillation occurrence compared with 1 year prior (IRR 1.33, 95% CI 1.25-1.40, p=< 0.001). The first 100 days of the COVID-19 pandemic were associated with a 33% increase in atrial fibrillation episodes among patients with CIEDs compared to 2019 (IRR 1.33; 95% CI 1.25-1.40; P<0.001).
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