Published online Sep 26, 2023. doi: 10.4330/wjc.v15.i9.448
Peer-review started: April 27, 2023
First decision: June 1, 2023
Revised: June 16, 2023
Accepted: July 17, 2023
Article in press: July 17, 2023
Published online: September 26, 2023
Processing time: 146 Days and 18.9 Hours
Coronavirus disease 2019 (COVID-19) tremendously impacted patients worldwide. While most research has focused on the virus's effects on the respiratory system, we set to understand the impact that the virus has on the cardiac conductive system. Research has strongly suggested that COVID-19 has a predilection to cardiac tissue. Fewer studies, however, have looked into the effect of the virus on the cardiovascular conductive system. With the availability of pacemakers, cardiac monitoring techniques, and the increasing burden of cardiac arrhythmias triggered by COVID-19, there is a dire need for new studies to establish this association on a larger patient population.
By identifying the gaps in the literature, and with the emergence of case reports and series reported about this topic, we acknowledged the need for large scale studies to draw statistically significant conclusions which could give rise to new interventions that could possibly mitigate life threatening cardiovascular outcomes in high risk patients.
The aim of our study was to analyze the impact that COVID-19 had on the odds of major cardiovascular complications in patients with newly diagnosed heart blocks and bundle branch blocks on a large patient sample. Our analysis was successful in measuring the cardiovascular impact caused by this virus with significance of our results supported by our large sample of patients and patient selection process. We included only patients with new onset high degree atrioventricular blocks or bundle branch blocks, presumed to be triggered by COVID-19 or its treatment. Regardless of causality, which was not the aim of our study, we demonstrated the large burden of serious and life-threatening complications inflicting our patient population. Therefore, our results may suggest that high-risk patients may benefit from early use of temporary pacemakers to mitigate the negative impact coronavirus has on patients with newly diagnosed heart blocks and bundle branch blocks.
Using the 2020 National Inpatient Sample database, we selected our patient population of interest, which included all patients hospitalized for COVID-19 pneumonia as the primary diagnosis, utilizing ICD-10 codes. To conduct our statistical analysis, we utilized STATA® (StataCorp, College Station, TX, United States) version 17. We further stratified our sample into patients who had a secondary diagnosis of either high degree atrioventricular blocks or bundle branch blocks. We excluded patients with prior pacemakers using ICD-10 procedure codes. Inpatient mortality was our primary outcome of interest while secondary outcomes included significant cardiac and noncardiac outcomes. Finally, multivariant and univariate regression analyses were conducted on both patient groups.
Our analysis demonstrated that patients with coronavirus 2019 pneumonia and newly diagnosed high degree atrioventricular blocks had a significantly increased odds of inpatient mortality, cardiac arrest, life-threatening tachyarrhythmias, need for mechanical ventilation, and cardiogenic shock. Patients with COVID-19 pneumonia and newly diagnosed bundle branch blocks experienced no significant increase in mortality on multivariate regression analysis however had similar other outcomes.
Our study identified high risk groups or patients prone to poor clinical outcomes. Elderly white males with common medical co-morbidities such as diabetes, chronic kidney disease, and peripheral artery disease who were hospitalized for COVID-19 pneumonia and developed high degree atrioventricular block or bundle branch blocks experienced worse clinical outcomes, and thus may benefit from temporary pacemaker placement or long term cardiac monitoring techniques. However, additional research is required to establish clear benefit from the utility of temporary pacemakers or continuous cardiac monitoring techniques on the outcomes experienced in this patient population. Although we identified the increased odds of possibly fatal complications experienced by this patient population, we were unable to measure the contribution of medications used during our patients' hospitalizations due to the limitations of the National Inpatient Sample database. Furthermore, we have no available data to discern the outcomes of these patients following their discharge. This information would be crucial in determining the predicted course of disease in these patients.
Future research with different methodology should focus on comparing outcomes of patients admitted with COVID-19 pneumonia with newly diagnosed heart blocks secondary to the virus and undergo temporary pacemaker placement to controls who do not. This will help draw conclusions and establish guidelines that can standardize the approach and utility of temporary pacemakers in high risk patients.