A Multicenter Retrospective Analysis on the Etiology of Bradycardia in COVID-19 Patients

Introduction Bradycardia has been reported in the setting of SARS-CoV2 (COVID-19) and appears to be an important cardiac manifestation with an association of mortality. However, the etiology of bradycardia in COVID-19 remains unclear. Therefore, this study aims to retrospectively investigate the potential causes of bradycardia in COVID-19 patients. Method The multicenter retrospective analysis consisted of 1,116 COVID-19 positive patients from March 2020 to March 2021. Bradycardia and severe bradycardia were defined as a sustained heart rate of <60 BPM and <50 BPM, respectively, on two separate occasions, a minimum of four hours apart during the hospitalization. End-of-life bradycardia was excluded from the study. Data were retrieved using a structured query language (SQL) program through the EMR, and data were analyzed using IBM SPSS 27.0 (IBM Corp., Armonk, NY). Logistic regression was used to study the bradycardic event and its association with remdesivir, beta-blockers, or steroids use during the patient's hospital stay. Result In the multivariate analysis, bradycardia was significantly associated with length of hospital stay (p<0.001), mortality (p=0.022), ventilator use (p=0.001), and steroid use (p=0.001). However, there was no significant association between bradycardia and remdesivir use (p=0.066) or beta-blocker use (p=0.789). Conclusion Our study showed that steroid use was protective against developing bradycardia in COVID-19 patients. Furthermore, remdesivir and the use of beta-blockers were not associated with bradycardia in COVID-19 patients. However, bradycardia was associated with both increased mortality and length of stay in the hospital. Therefore, future studies should focus on the mechanism of bradycardia in COVID-19 patients and the effect of bradycardia on patient outcomes.