To implement the set goals and objectives, an open prospective comparative
single-center study was conducted, in which the data obtained during the clinical,
instrumental and laboratory examination of 248 people were analyzed: 165 patients with
AF (116 of the main group and 49 of the 1st control group), 22 patients with ventricular
extrasystole (VE) and atrial extrasystole (2nd control group), 41 patients with other
heart rhythm and conduction disorders that were detected during the screening study,
and 20 practically healthy people (3rd control group) were not included in the main part
of the work .
At the first stage of the research, a screening analysis of the types of heart
rhythm and conduction disorders with which patients with COVID-19 infection were
hospitalized in the Department of Clinical Arrhythmology and Electrophysiology of the
State Institution "National Research Center "Institute of Cardiology named after
Academician M.D. Strazhesk" was carried out of the National Academy of Medical
Sciences of Ukraine" for 15 months: from September 20, 2020 to December 21, 2021.
At the same time, the following percentage of occurrence of these arrhythmias
was established in 179 hospitalized patients (in decreasing order): atrial fibrillation -
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116 patients (64.8 %), paroxysmal form - in 49 patients (27.4 %), persistent form - in 45
patients (25.1%), permanent form – in 22 patients (12.3%). Other heart rhythm and
conduction disorders were the cause of hospitalization for 63 patients (35.2%), which
was probably less (p<0.001) than AF.
The results of a screening study of patients who suffered from a COVID-19
infection and were hospitalized in the clinic indicate that: Corona virus disease (CD)
significantly worsens the course of AF. Thus, in the majority of patients - 65% (that is,
almost 2/3 of the total number) after CD, the reason for hospitalization was atrial
fibrillation (AF) (p<0.001). The course of post-CH AF was likely to worsen clinically in
60 of 80 patients (75.0%) (p<0.001) who had this arrhythmia prior to COVID-19
infection (CI). In 31% of patients AF was detected for the first time an average of 2
months after the CI and can be considered as "denovo".
207 people were included in the main part of the examination after screening.
Among them, 116 patients with AF aged from 35 to 80 years, on average 63.8 ± 0.6
years: 56 men and 60 women, who from 1 to 12 months ago (on average 5.1 ± 0.2
months) were infected with COVID-19. They made up the main group of examined
patients.
As the first control (K1), 49 patients with AF without a history of CI were
examined: 34 men and 15 women aged 35 to 80 years (mean age 59.0 ± years).
According to the percentage of patients with paroxysmal, persistent and permanent
forms of AF, the groups of examined patients were comparable.
As the second control group (K2), a group of patients who underwent CI, but
who did not develop AF, was formed. This group included 22 patients hospitalized in
the clinic with a diagnosis of extrasystole: 8 with supraventricular and 14 with
ventricular premature excitation.
A control group of practically healthy people (K3) - 20 people, was created to
obtain reference values during laboratory tests.
It was established that patients with AF who underwent CD were on average
2.8 years older and had a large comorbidity. Thus, 92% of patients had HF of the I-IIA
stage, and in more than half of the cases - in 51% it was HF of the IIA stage,
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hypertension occurred in 83% of patients, higher SBP and DBP at the time of inclusion
in the study, had coronary heart disease 60% of patients; overweight or obesity occurred
in 60% of cases, 28% of patients had a history of ICD, 12% of patients had diabetes,
and 5% of patients were diagnosed with ICD. Among the patients who underwent CI
and had AF before this infection, there were significantly more women than men, both
in the comparison between them, where the ratio was 1.16:1.0, and in compared with
the control group, where the ratio was 0.44:1.0 (p<0.001). As a result, among AF
patients who underwent CI compared with patients in the control group, which included
patients with AF but no history of COVID-19 infection, there were 1.6 times more
likely to have CHADS2- VASc2 3 points and above, i.e. high risk of thrombosis, and
2.1 times more those who had HASBLED 2 points and above, i.e. medium and high risk
of bleeding.
