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Risk of arrhythmias following COVID-19: nationwide self-controlled case series and matched cohort study
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. (Krister Lindmark)ORCID iD: 0009-0009-8239-2442
Umeå University, Faculty of Medicine, Department of Clinical Microbiology. (Anne-Marie Fors Connolly)ORCID iD: 0000-0002-5328-9536
Umeå University, Faculty of Medicine, Department of Clinical Microbiology. (Anne-Marie Fors Connolly)
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden. (Krister Lindmark)ORCID iD: 0000-0002-5756-7791
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2023 (English)In: European Heart Journal Open, E-ISSN 2752-4191, Vol. 3, no 6, article id oead120Article in journal (Refereed) Published
Abstract [en]

Aims: COVID-19 increases the risk of cardiovascular disease, especially thrombotic complications. There is less knowledge on the risk of arrhythmias after COVID-19. In this study, we aimed to quantify the risk of arrhythmias following COVID-19.

Methods and Results: This study was based on national register data on all individuals in Sweden who tested positive for SARS-CoV-2 between 1 February 2020 and 25 May 2021. The outcome was incident cardiac arrhythmias, defined as international classification of diseases (10th revision) codes in the registers as follows: atrial arrhythmias; paroxysmal supraventricular tachycardias; bradyarrhythmias; and ventricular arrhythmias. A self-controlled case series study and a matched cohort study, using conditional Poisson regression, were performed to determine the incidence rate ratio and risk ratio, respectively, for an arrhythmia event following COVID-19.A total of 1 057 174 exposed (COVID-19) individuals were included in the study as well as 4 074 844 matched unexposed individuals. The incidence rate ratio of atrial tachycardias, paroxysmal supraventricular tachycardias, and bradyarrhythmias was significantly increased up to 60, 180, and 14 days after COVID-19, respectively. In the matched cohort study, the risk ratio during Days 1–30 following COVID-19/index date was 12.28 (10.79–13.96), 5.26 (3.74–7.42), and 3.36 (2.42–4.68), respectively, for the three outcomes. The risks were generally higher in older individuals, in unvaccinated individuals, and in individuals with more severe COVID-19. The risk of ventricular arrhythmias was not increased.

1 057 174 exposed (COVID-19) individuals were included in the study as well as 4 074 844 matched unexposed individuals. The incidence rate ratio of atrial tachycardias, paroxysmal supraventricular tachycardias and bradyarrhythmias was significantly increased up to 60, 180 and 14 days after COVID-19, respectively. In the matched cohort study, the risk ratio during day 1-30 following COVID-19/index date was 12.28 (10.79-13.96), 5.26 (3.74-7.42) and 3.36 (2.42-4.68), respectively for the three outcomes. The risks were generally higher in older individuals, unvaccinated individuals and in individuals with more severe COVID-19. The risk of ventricular arrhythmias was not increased.

Conclusion: There is an increased risk of cardiac arrhythmias following COVID-19, and particularly increased in elderly vulnerable individuals, as well as in individuals with severe COVID-19.

Place, publisher, year, edition, pages
Oxford University Press, 2023. Vol. 3, no 6, article id oead120
Keywords [en]
COVID-19, SARS-CoV-2, cardiology, arrhythmia, atrial arrhythmias, paroxysmal supraventricular tachycardias, bradyarrhythmias, ventricular arrhythmias, nationwide study, matched cohort study, self-controlled case series study
National Category
Clinical Medicine
Research subject
Infectious Diseases; Public health; Epidemiology; Cardiology
Identifiers
URN: urn:nbn:se:umu:diva-217231DOI: 10.1093/ehjopen/oead120Scopus ID: 2-s2.0-85180103321OAI: oai:DiVA.org:umu-217231DiVA, id: diva2:1815026
Projects
Risks of arrhythmias after covid-19: nationwide self-controlled cases series and matched cohort studyCardiovascular complications following covid-19: population-based register studies
Funder
Region Västerbotten, RV-967545Region Västerbotten, RV-967738Region Västerbotten, RV-982300Swedish Research Council, 2021-06536Swedish Heart Lung Foundation, 20220179Swedish Heart Lung Foundation, 202207232The Swedish Heart and Lung Association, FA 2022/6The Kempe Foundations, SMK21-0014Hedlund foundation, M-2022-1753
Note

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

Available from: 2023-11-27 Created: 2023-11-27 Last updated: 2023-12-27Bibliographically approved

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Katsoularis, IoannisJerndal, HannaKalucza, SebastianLindmark, KristerFonseca Rodriguez, OsvaldoFors Connolly, Anne-Marie

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