Relationship between atrial fibrillation and P wave dispersion in inpatients with COVID-19

Year 2023, , 181 - 189, 30.12.2023

Hayati Eren , Muhammed Bahadır Omar , Ülker Kaya , Sedat Akkan , Zehra Demirbaş

https://doi.org/10.17944/interdiscip.1410386

Abstract

Objective: Various cardiac arrhythmias, primarily atrial fibrillation (AF), have been reported to occur in 7% to 22% of patients hospitalized due to coronavirus disease 2019 (COVID-19). It has been shown that P wave dispersion (PWD) predicts the development of AF in different clinical situations and is closely related to the inflammatory process. The aim of this study is to determine the relationship between PWD and the development of new-onset AF in hospitalized patients due to COVID-19.

Methods: 51 COVID-19 patients who developed AF and 72 COVID-19 patients who did not develop AF were included in the study as the control group retrospectively. Electrocardiography (ECG) was performed in all patients and PWD was calculated. In addition, demographic data, imaging findings and laboratory test results of all COVID-19 patients were obtained from the institutional digital database and recorded.

Results: Patients who developed AF were older and had a higher frequency of hypertension and heart failure (p<0.05 for all). Patients who developed AF during hospitalization had higher neutrophil/lymphocyte ratio (NLR), C-reactive protein (CRP) (p<0.05 for all)). The PWD value was significantly longer in the AF group (p<0.05). In addition, a significant positive correlation was observed between PWD and cTn-I, CRP and NLR.

Conclusion: Our study showed that PWD predicts new-onset AF during follow-up of COVID-19 patients and is associated with inflammatory markers. Multivariate logistic regression analysis showed that PWD is an independent predictor of AF development. We believe that pretreatment PWD assessment in COVID-19 patients may be useful in estimating the risk of AF.

Keywords

P Wave Dispersion, COVID-19, Atrial Fibrillation

References

• Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020 Mar 17;323 (11):1061-1069. Erratum in: JAMA. 2021 Mar 16;325 (11):1113. https://doi.org/10.1001/jama.2020.2648
• Pan A, Liu L, Wang C, Guo H, Hao X, Wang Q, et al. Association of Public Health Interventions With the Epidemiology of the COVID-19 Outbreak in Wuhan, China. JAMA. 2020 May 19;323 (19):1915-1923. https://doi.org/10.1001/jama.2020.6130.
• Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb 15;395 (10223):497-506. Epub 2020 Jan 24. Erratum in: Lancet. 2020 Jan 30;: https://doi.org/10.1016/S0140-6736 (20)30183-5
• Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19) [published correction appears in JAMA Cardiol. 2020 Jul 1;5 (7):848]. JAMA Cardiol. 2020;5 (7):811-818 https://doi.org/10.1001/jamacardio.2020.1017
• Iacopino S, Placentino F, Colella J, P Francesca, Pardeo A, Filannino P, et al. New-Onset Cardiac Arrhythmias During COVID-19 Hospitalization. Circ Arrhythm Electrophysiol. 2020;13 (11):e009040. https://doi.org/10.1161/CIRCEP.120.009040
• Peltzer B, Manocha KK, Ying X, Kirzner J, Ip JE, Thomas G, et al. Arrhythmic Complications of Patients Hospitalized With COVID-19: Incidence, Risk Factors, and Outcomes. Circ Arrhythm Electrophysiol. 2020;13 (10):e009121. https://doi.org/10.1161/CIRCEP.120.009121
• Report sulle caratteristiche dei pazienti deceduti positivi a COVID-19 in Italia Il presente report è basato sui dati aggiornati al 20 Marzo 2020. https://www.epicentro.iss.it/coronavirus/ sars-cov-2-decessi-italia (accessed May 31, 2020).
• Inciardi RM, Adamo M, Lupi L, Cani DS, Di Pasquale M, Tomasoni D, et al. Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy [published correction appears in Eur Heart J. 2020 Dec 21;41 (48):4591]. Eur Heart J. 2020;41 (19):1821-1829. https://doi.org/10.1093/eurheartj/ehaa388
• Aytemir K, Ozer N, Atalar E, Sade E, Aksöyek S, Ovünç K, et al. P wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol. 2000;23 (7):1109-1112. https://doi.org/10.1111/j.1540-8159.2000.tb00910.x
• Okutucu S, Aytemir K, Oto A. P-wave dispersion: What we know till now? JRSM Cardiovasc Dis. 2016 Mar 21;5:2048004016639443. https://doi.org/10.1177/2048004016639443.
• Magnani JW, Mazzini MJ, Sullivan LM, Williamson M, Ellinor PT, Benjamin EJ. P-wave indices, distribution and quality control assessment (from the Framingham Heart Study). Ann Noninvasive Electrocardiol. 2010;15 (1):77-84. https://doi.org/10.1111/j.1542-474X.2009.00343.x
• Dilaveris PE, Gialafos JE. P-wave dispersion: a novel predictor of paroxysmal atrial fibrillation. Ann Noninvasive Electrocardiol. 2001;6 (2):159-165. https://doi.org/10.1111/j.1542-474x.2001.tb00101.x
• Kochi AN, Tagliari AP, Forleo GB, Fassini GM, Tondo C. Cardiac and arrhythmic complications in patients with COVID-19. J Cardiovasc Electrophysiol. 2020;31 (5):1003-1008. https://doi.org/10.1111/jce.14479
• Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol. 2020;84:106504. https://doi.org/10.1016/j.intimp.2020.106504
• Chan AS, Rout A. Use of Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in COVID-19. J Clin Med Res. 2020;12 (7):448-453. https://doi.org/10.14740/jocmr4240
• Lissoni P, Rovelli F, Monzon A, Privitera1 C, Messina1 G, Porro G, et al. Evidence of abnormally low lymphocyte-to-monocyte ratio in covid-19-induced severe acute respiratory syndrome. J Immuno Allerg 2020;1:1–6. https://doi.org/10.37191/Mapsci-2582-6549-1 (2)-011
• Ministry of Health. COVID-19 rehberi. Republic of Turkey Ministry of Health; 2020. https://covid19bilgi.saglik.gov.tr/depo/ rehberler/COVID-19 _Rehberi.pdf. [Accessed 17 April 2020]
• World Health Organization. Clinical management of severe acute respiratoryinfection when novel coronavirus (nCoV) infection is suspected: interim guidance. World Health Organization; 2020. Available from: https://www.who.int/publications-detail/clinicalmanagement-ofsevereacute- respiratory-infection-when-novelcoronavirus- (ncov)-infectionis- suspected. [Accessed 29 March 2020]
• Corman VM, Landt O, Kaiser M, Molenkamp R, Meijer A, Chu DK, et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Eurosurveillance 2020 Jan 23;25(3). http://dx.doi.org/10.2807/1560-7917.es.2020.25.3.2000045
• Pérez-Riera AR, de Abreu LC, Barbosa-Barros R, Grindler J, Fernandes-Cardoso A, Baranchuk A. P-wave dispersion: an update. Indian Pacing Electrophysiol J. 2016;16 (4):126-133. https://doi.org/10.1016/j.ipej.2016.10.002
• Bazett H. An analysis of the time-relations of electrocardiograms. Heart 1920;7:353–370
• Quiñones MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA. Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr. 2002;15 (2):167-184. https://doi.org/10.1067/mje.2002.120202
• Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential Effects of Coronaviruses on the Cardiovascular System: A Review. JAMA Cardiol. 2020;5 (7):831-840. https://doi.org/10.1001/jamacardio.2020.1286
• Corman VM, Muth D, Niemeyer D, Drosten C. Hosts and Sources of Endemic Human Coronaviruses. Adv Virus Res. 2018;100:163-188. https://doi.org/10.1016/bs.aivir.2018.01.001
• The European Society for Cardiology. ESC Guidance for the Diagnosis and Management of CV Disease during the COVID-19 Pandemic. https:// www.escardio.org/Education/ COVID-19 and Cardiology/ESCCOVID-19-Guidance. [Last updated 10 June 2020]
• Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020 Apr;8 (4):420-422. Epub 2020 Feb 18. Erratum in: Lancet Respir Med. 2020 Feb 25;: https://doi.org/10.1016/S2213-2600 (20)30076-X.
• Guo Y, Lip GY, Apostolakis S. Inflammation in atrial fibrillation. J. Am. Coll. Cardiol. 60(22), 2263–2270 (2012).
• Liu T, Li G, Li L, Korantzopoulos P. Association between c-reactive protein and recurrence of atrial fibrillation after successful electrical cardioversion: a meta-analysis. J. Am. Coll. Cardiol. 49, 1642–1648 (2007).
• Lin YJ, Tsao HM, Chang SL, Lo LW, Tuan TC, Hu YF, et al. Prognostic implications of the high-sensitive c-reactive protein in the catheter ablation of atrial fibrillation. Am. J. Cardiol. 105, 495–501 (2010).
• Wang L. C-reactive protein levels in the early stage of COVID-19. Med Mal Infect. 2020;50(4):332-334. https://doi.org/10.1016/j.medmal.2020.03.007.
• Lagunas-Rangel FA. Neutrophil-to-lymphocyte ratio and lymphocyte-to-C-reactive protein ratio in patients with severe coronavirus disease 2019 (COVID-19): A meta-analysis. J Med Virol. 2020;92(10):1733-1734. https://doi.org/10.1002/jmv.25819
• Kelesoglu S, Yilmaz Y, Ozkan E, Calapkorur B, Gok M, Dursun ZB, et al. New onset atrial fibrilation and risk faktors in COVID-19. J Electrocardiol. 2021;65:76-81. https://doi.org/10.1016/j.jelectrocard.2020.12.005.
• Canpolat U, Aytemir K, Yorgun H, Şahiner L, Kaya EB, Kabakçı G, et al. Role of preablation neutrophil/lymphocyte ratio on outcomes of cryoballoon-based atrial fibrillation ablation. Am. J. Cardiol. 112(4), 513–519 (2013).
• Azab B, Shah N, Akerman M, McGinn JT Jr. Value of platelet/lymphocyte ratio as a predictor of all-cause mortality after non-ST-elevation myocardial infarction. J. Thromb. Thrombolysis 34, 326–334 (2012).
• Demirag MK, Bedir A. Evaluation of preoperative neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in patients undergoing major vascular surgery. Turk. Gogus. Kalp. Damar. 21, 930–935 (2013).
• Gungor H, Babu AS, Zencir C, Akpek M, Selvi M, Erkan MH, et al. Association of preoperative platelet-to-lymphocyte ratio with atrial fibrillation after coronary artery bypass graft surgery. Med. Princ. Pract. 26(2), 164–168 (2017).
• Magnani JW, Williamson MA, Ellinor PT, Monahan KM, Benjamin EJ. P wave indices: current status and future directions in epidemiology, clinical, and research applications. Circ Arrhythm Electrophysiol. 2009;2(1):72-79. https://doi.org/10.1161/CIRCEP.108.806828.
• Yenerçağ M, Arslan U, Şeker OO, Dereli S, Kaya A, Doğduş M, et al. Evaluation of P-wave dispersion in patients with newly diagnosed coronavirus disease 2019. J Cardiovasc Med (Hagerstown). 2021 Mar 1;22(3):197-203 39-Yalta T, Yalta K. Systemic Inflammation and Arrhythmogenesis: A Review of Mechanistic and Clinical Perspectives. Angiology. 2018;69 (4):288-296. https://doi.org/10.1177/0003319717709380.
• Korantzopoulos P, Letsas KP, Tse G, Fragakis N, Goudis CA, Liu T. Inflammation and atrial fibrillation: A comprehensive review. J Arrhythm. 2018;34 (4):394-401. Published 2018 Jun 4. https://doi.org/10.1002/joa3.12077.
• Packer M. Characterization, Pathogenesis, and Clinical Implications of Inflammation-Related Atrial Myopathy as an Important Cause of Atrial Fibrillation. J Am Heart Assoc. 2020;9 (7):e015343. https://doi.org/10.1161/JAHA.119.015343
• Atri D, Siddiqi HK, Lang JP, Nauffal V, Morrow DA, Bohula EA. COVID-19 for the Cardiologist: Basic Virology, Epidemiology, Cardiac Manifestations, and Potential Therapeutic Strategies. JACC Basic Transl Sci. 2020;5 (5):518-536. Published 2020 Apr 10. https://doi.org/10.1016/j.jacbts.2020.04.002