The Link Between SARS-CoV-2 Infection and New-Onset Atrial Fibrillation

Atrial fibrillation (AF) is a prevalent cardiac arrhythmia characterized by irregular and often rapid heartbeats, leading to an increased risk of stroke, heart failure, and mortality.

The year 2020 marked a significant global health crisis with the emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing the coronavirus disease 2019 (COVID-19) pandemic.

While much attention has been focused on the respiratory complications of COVID-19, emerging evidence has suggested potential cardiovascular involvement, including arrhythmias like AF.

New-onset AF (NOAF) has recently garnered attention due to its potential association with SARS-CoV-2 infection. However, the exact nature of this link remains largely unexplored.

In a groundbreaking study titled “Association Between SARS-CoV-2 Infection and New-Onset Atrial Fibrillation,” researchers aimed to delve into this intriguing connection and shed light on its implications for clinical practice.

Methods

Conducted within the largest healthcare provider in Israel, this nested-case control study employed a robust methodology to investigate the potential relationship between SARS-CoV-2 infection and NOAF. The cohort comprised 2,931,046 adults who were followed from March 1st, 2020, until June 30th, 2022.

During this period, the occurrence of NOAF was meticulously tracked. To ensure a comprehensive analysis, ten controls were meticulously matched to each NOAF case based on age, sex, and duration of follow-up.

The exposure of interest, SARS-CoV-2 infection, was assessed in both cases and controls within the prior 30 days. To account for potential biases and confirm the specificity of the observed association, a lag-time analysis was conducted. Additionally, a negative control exposure, represented by low back pain, was used to evaluate the validity of the findings.

Results

Over the course of the study, 18,981 patients developed NOAF and were matched to 189,810 controls. The study population had a mean age of 73.8 years, with approximately 51.1% being women. Multivariable analysis unveiled a significant link between SARS-CoV-2 infection and an increased risk of NOAF. The adjusted odds ratio (OR) for this association was 4.24, with a 95% confidence interval (CI) of 3.89–4.62.

The credibility of this association was further reinforced through the lag-time analysis, which revealed a gradual attenuation of the association’s strength with increasing lag-time. Interestingly, the association stabilized around a lag-time of approximately 20 days, suggesting a nuanced temporal relationship.

To ascertain the specificity of the findings, the study assessed the impact of the negative control exposure (low back pain) on NOAF. The analysis indicated a comparatively modest risk increase, with an adjusted OR of 1.13 and a 95% CI of 1.02–1.26.

Conclusion

In light of the study’s comprehensive findings, it can be confidently concluded that SARS-CoV-2 infection is indeed associated with an elevated risk of new-onset atrial fibrillation. This study’s significance extends beyond its immediate implications, offering a deeper understanding of the multi-faceted consequences of COVID-19 on cardiovascular health.

Clinicians and researchers alike are urged to consider the potential cardiac manifestations of COVID-19, especially in patients presenting with new-onset AF. As the world continues to grapple with the aftermath of the pandemic, this study underscores the need for ongoing vigilance and comprehensive care in managing the long-term cardiovascular effects of SARS-CoV-2 infection.

reference link: https://www.sciencedirect.com/science/article/abs/pii/S0167527323011774