ArticleJACC. Clinical electrophysiology2021
Atrial Fibrillation in Patients Hospitalized With COVID-19: Incidence, Predictors, Outcomes, and Comparison to Influenza.
Article in JACC. Clinical electrophysiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 85 papers, 5 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
85 citing papers in PubMed, 5 syntheses or guidelines pooled it, 124 citations in OpenAlex.
- Corticosteroid Use and Atrial Fibrillation: Exploring Underlying Mechanisms, FAERS Disproportionality Analysis, and a Meta-Analysis of Clinical Studies.Cardiovascular toxicology · 2026Pooled it
- Prevalence of new-onset atrial fibrillation in hospitalized patients with community-acquired pneumonia: a systematic review and meta-analysis.Internal and emergency medicine · 2023Pooled it
- 2022 AHA/ACC Key Data Elements and Definitions for Cardiovascular and Noncardiovascular Complications of COVID-19: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards.Journal of the American College of Cardiology · 2022Guideline
- 2021 Focused Update Consensus Guidelines of the Asia Pacific Heart Rhythm Society on Stroke Prevention in Atrial Fibrillation: Executive Summary.Thrombosis and haemostasis · 2022Guideline
- Outcomes and mortality associated with atrial arrhythmias among patients hospitalized with COVID-19: A systematic review and meta-analysis.Cardiology journalPooled it
- Patterns and trends in atrial fibrillation and atrial flutter incidence rates in G20 countries (1990-2021) and predictions to 2050.Medicine · 2026Article
- Atrial Fibrillation and Documented Heart Failure in Patients Hospitalized with COVID-19: A Secondary Analysis of a Single-Centre Cohort from Western Romania.Journal of clinical medicine · 2026Article
- Mortality trends in older adults (55-84 years) with sepsis-atrial fibrillation: a CDC database analysis.BMC public health · 2026Article
- Review
- Article
- Electronic nudges to increase influenza vaccination uptake in younger and middle-aged individuals with atrial fibrillation: a prespecified analysis of the NUDGE-FLU-CHRONIC trial.European heart journal open · 2026Article
- Innate immune activation and mitochondrial ROS induce acute and persistent cardiac conduction system dysfunction after COVID-19.JCI insight · 2025Article
- Atrial Fibrillation in COVID-19: Mechanisms, Clinical Impact, and Monitoring Strategies.Biomedicines · 2025Review
- Atrial fibrillation and flutter in the Eastern Mediterranean: burden, disparities, and risk factor contributions from 1990 to 2021.The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology · 2025Article
- Cardiovascular Complications of COVID-19 Disease: A Narrative Review.Diseases (Basel, Switzerland) · 2025Review
- The Risk of Arrhythmias in Patients with COVID-19.Biomedicines · 2025Article
- The cardiovascular effects of interleukin-6 inhibition in patients with severe coronavirus-19 infection.The Journal of international medical research · 2025Article
- Three decades of atrial fibrillation and flutter epidemiology and risk factors in Iran with a focus on the impact of COVID-19.Scientific reports · 2025Article
- Viral Myocarditis.The Yale journal of biology and medicine · 2024Review
- COVID-19 and Cardiac Arrhythmias: Lesson Learned and Dilemmas.Journal of clinical medicine · 2024Article
25 more citing papers are in PubMed but not listed here.
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Authors and funding
31 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThe goal of this study is to determine the incidence, predictors, and outcomes of atrial fibrillation (AF) or atrial flutter (AFL) in patients hospitalized with coronavirus disease-2019 (COVID-19).
backgroundCOVID-19 results in increased inflammatory markers previously associated with atrial arrhythmias. However, little is known about their incidence or specificity in COVID-19 or their association with outcomes.
methodsThis is a retrospective analysis of 3,970 patients admitted with polymerase chain reaction-positive COVID-19 between February 4 and April 22, 2020, with manual review performed of 1,110. The comparator arm included 1,420 patients with influenza hospitalized between January 1, 2017, and January 1, 2020.
resultsAmong 3,970 inpatients with COVID-19, the incidence of AF/AFL was 10% (n = 375) and in patients without a history of atrial arrhythmias it was 4% (n = 146). Patients with new-onset AF/AFL were older with increased inflammatory markers including interleukin 6 (93 vs. 68 pg/ml; p < 0.01), and more myocardial injury (troponin-I: 0.2 vs. 0.06 ng/ml; p < 0.01). AF and AFL were associated with increased mortality (46% vs. 26%; p < 0.01). Manual review captured a somewhat higher incidence of AF/AFL (13%, n = 140). Compared to inpatients with COVID-19, patients with influenza (n = 1,420) had similar rates of AF/AFL (12%, n = 163) but lower mortality. The presence of AF/AFL correlated with similarly increased mortality in both COVID-19 (relative risk: 1.77) and influenza (relative risk: 1.78).
conclusionsAF/AFL occurs in a subset of patients hospitalized with either COVID-19 or influenza and is associated with inflammation and disease severity in both infections. The incidence and associated increase in mortality in both cohorts suggests that AF/AFL is not specific to COVID-19, but is rather a generalized response to the systemic inflammation of severe viral illnesses.
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