The COVID-19 global pandemic presents with a wide range of clinical manifestations, including biochemical, echocardiographic, and electrocardiographic (ECG) evidence of myocardial involvement (1–3). However, the occurrence of atrial arrhythmias in patients with this infection and how these arrhythmias impact the clinical course of patients with COVID-19 has not been well described. In an Institutional Review Board–approved protocol, we analyzed the 12-lead ECGs and telemetry of all patients admitted to the University of Alabama at Birmingham Hospital between February 29, 2020, and April 10, 2020, with polymerase chain reaction–proven SARS-CoV-2 infection.

There were 115 patients admitted with COVID-19, including 69 patients admitted to the medical intensive care unit (MICU) and 46 patients admitted to a general medicine ward. The age was 56+ 17 years, including 54% men. There were 64 African American, 41 White, and 10 Asian or Hispanic individuals. Underlying comorbidities included hypertension in 70%, current or former tobacco use in 42%, diabetes in 39%, coronary artery disease in 16%, chronic kidney disease in 14%, and chronic obstructive lung disease in 13%. An atrial tachyarrhythmia that had not been present on admission was recorded on a subsequent 12-lead ECG in 19 patients (16.5%), all admitted to the MICU (27.5% of MICU patients). In contrast, no patient admitted to the general inpatient service developed atrial arrhythmias (p= 0.00002). These arrhythmias included atrial fibrillation in 12 patients, atrial flutter in 6 patients, and atrial tachycardia in 1 patient. Compared with patients without atrial tachyarrhythmias, those with atrial fibrillation, flutter, or tachycardia tended to be older with higher concentrations of C-reactive protein (CRP) and d-dimer, but had similar levels of brain natriuretic peptide (BNP) and high-sensitivity troponin (Table 1). Five MICU patients reported a history of atrial fibrillation before admission, including 3 of 19 who developed atrial arrhythmias and 2 of 50 who did not (p= 0.12). Although not reaching statistical significance, patients of white race tended to have a higher risk of developing atrial arrhythmias. Prior use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers was similar among patients with and without atrial arrhythmias. No