Surviving critical COVID-19 requiring mechanical ventilation is associated with a high long-term risk of de novo arrhythmic events

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish Research Council Swedish Heart- and Lung Foundation BACKGROUND: The long-term risk of de novo arrhythmic events after severe COVID-19 requiring intensive care is largely unknown, especially after adjusting for multiple risk factors such as co-morbidities and socio-economic factors. OBJECTIVE: The primary objective of this study was to investigate the long-term, co-variate adjusted risk of arrhythmic event after discharge from intensive care unit for critical COVID-19. METHODS: We performed a nationwide case-control study on patients with severe COVID-19 (cases) treated with mechanical ventilation and discharged alive from an intensive care unit. Each case was matched (age, sex, district of residence) with up to 10 population-based control. The study database from the Swedish ICU register was merged with multiple compulsory national registries. The primary outcome was hospitalizations with the following arrhythmias identified: ventricular tachycardia, atrial fibrillation, any other tachy-arrhythmia, or bradycardia/pacemaker implantation. Hazard ratios were adjusted for co-morbidities, socioeconomic status, level of education, region of birth and disposable income. Average follow-up was 12 months. RESULTS: We included 3 023 patients with severe COVID-19 that were treated with mechanical ventilation at a Swedish ICU (March 1, 2020 to June 8, 2021) and were discharged alive. Control subjects (n= 28,463 ) were selected based on matching by age, sex and district of residence. The Hazard ratios for the risk of de novo arrhythmic event post ICU discharge for COVID-19 adjusted for age, gender, all comorbidities, level of education, marital status and income were increased between 13.1 – 21.0 in all four types of arrhythmias (Table 1). CONCLUSIONS: We report increased risks for major arrhythmic events following severe COVID-19 even after adjusting for cardiovascular risk factors and for socio-economic factors. These data suggest that at least patients with inherit risk factors for developing arrhythmias in need of ICU treatment for COVID-19 should be closely followed-up after discharge. [Figure: see text]