Abstract 14980: Describing Atrioventricular Conduction in Patients With Chronic Atrial Fibrillation During Hospitalization for COVID-19 - Less RR Interval Variation is Associated With Worse Outcomes
Introduction: Myriad cardiovascular manifestations have been reported with COVID-19. We previously reported that failure of PR interval shortening with increasing heart rate (HR) in COVID-19 patients (pts) is associated with adverse outcomes. Here we report on atrioventricular (AV) conduction and clinical outcomes in pts with chronic atrial fibrillation (cAF) while hospitalized for COVID-19. Methods: A retrospective review of all admitted (Feb 01 - Jun 01) COVID-19 pts with cAF was performed. Clinical and ECG characteristics were collected. The ventricular response in cAF was compared during pre-COVID-19 to COVID-19 admissions. Mean HR, shortest RR, and longest RR intervals were recorded. Regularization of ventricular rate was assessed by difference between the longest and shortest RR intervals (ΔRR), with a smaller ΔRR indicating greater regularization. The cohort was divided into tertiles based on ΔRR. Clinical outcomes during COVID-19 were correlated to AV conduction based on the ventricular response. Results: A total of 189 ECGs (106 pre-COVID-19, 83 COVID-19) from 34 patients were included. Mean age 78.6 ± 11.4 years, male 48.6%. Comparing pre-COVID-19 vs. COVID-19 ECGs of all patients showed: mean HR (95.0 ± 24.3 vs. 99.5 ± 23.5 BPM; p=0.20), shortest conducted RR interval (514.9 ± 133.3 vs. 502.5 ± 141.6 ms; p=0.53), longest conducted RR interval (932.2 ± 250.0 vs. 794.7 ± 168.0 ms; p), and ΔRR range (417.3 ± 165.7 vs. 292.2 ± 104.2 ms; p). Pts who showed a more regularized ventricular response (smaller ΔRR) during a COVID-19 admission had longer ICU length of stay and numerically greater need for intubation (Table 1). Conclusion: In pts with cAF, the average ventricular rates were more regularized during COVID-19 compared to prior illnesses with comparable HRs. Importantly, pts with the most regularized ventricular response were more likely to have a longer ICU stay compared to pts whose ventricular rate was more irregular. Download figure