Preexisting Arrhythmia and COVID-19: Potential Risks and Treatment

Several reports have found that preexisting arrhythmia, specifically AFib, is associated with an increased risk of death due to COVID-19. Another report found that AFib was associated with increased:

• admission to the intensive care unit
• use of mechanical ventilation
• need for repeat hospitalization

A 2021 study of people with AFib found that the preexisting use of blood clot-preventing drugs lowered the risk of COVID-19 death. These types of drugs are used by some people with AFib to lower the risk of blood clots.

The way AFib may contribute to an increased risk of death due to COVID-19 is unknown. Several factors could be at play, likely in combination with each other, including:

• direct viral infection of the heart, which may damage heart tissue or disrupt the electrical impulses involved in heartbeats
• the immune system’s response to the infection, which can lead to increased inflammation throughout your body
• the higher risk of blood clots associated with COVID-19
• low blood oxygen levels, which may damage heart tissue
• electrolyte imbalances and dehydration

It’s important to know that most of the research into AFib and COVID-19 has been done in people already hospitalized with COVID-19. As such, it’s unclear what effect mild or moderate COVID-19 illness would have on people with AFib.

Most mild to moderate cases of COVID-19 can be treated with at-home care. This typically involves:

• staying hydrated
• getting plenty of rest
• using over-the-counter (OTC) medications to ease symptoms such as fever and aches and pains

The CDC recommends that people with preexisting health conditions continue to take their medications as directed by a doctor. If you have COVID-19 and are concerned about your arrhythmia medications, try to contact a doctor.

When to see a doctor

It’s also important to contact a doctor if you notice that your arrhythmia symptoms are worsening when you’re ill. Some examples of symptoms to look out for are:

• heart palpitations
• dizziness
• fatigue
• shortness of breath
• chest pain

Call 911 or local emergency services or seek immediate medical attention if you have any of the following symptoms. These are signs that your COVID-19 has become serious:

• difficulty breathing
• pain or pressure in your chest that doesn’t go away
• trouble with staying awake or with waking up
• skin, lips, or nails that are pale, blue, or gray in color
• confusion

It’s possible for COVID-19 to lead to arrhythmia in people without a preexisting heart condition. A 2021 study included 4,526 people hospitalized with COVID-19, 827 (about 18%) of whom developed an arrhythmia. It also found that:

• Atrial arrhythmias were most common, followed by ventricular arrhythmias and bradyarrhythmias.
• People who developed arrhythmia were more likely to have other conditions such as high blood pressure, diabetes, and heart failure.
• Arrhythmias were associated with high morbidity and mortality.

Other studies found an increased risk of new onset AFib in people hospitalized with COVID-19. Some further research has found that a COVID-19 vaccination reduces the risk of new onset AFib in those hospitalized with COVID-19.

A 2022 study found that COVID-19 was associated with an increased risk of cardiovascular complications 1 year after recovery, even in people who weren’t hospitalized. In addition to arrhythmia, complications also included:

• coronary artery disease
• serious blood clots
• myocarditis or pericarditis
• heart failure
• heart attack
• transient ischemic attack or stroke

Getting the COVID-19 vaccine is vital for preventing serious illness due to COVID-19. The COVID-19 vaccine is safe for people with preexisting arrhythmia.

The American Heart Association encourages people with arrhythmia, specifically AFib, to get vaccinated as soon as they can. They note that people with AFib often have other conditions that increase risks, such as heart failure or diabetes.

Severe side effects due to the COVID-19 vaccine are rare. The most common side effects are mild and go away after a few days. These include:

• redness, pain, or swelling at the injection site
• fatigue
• fever, with or without chills
• muscle aches and pains
• headache
• nausea

In addition to staying up to date on your COVID-19 vaccinations, other ways to prevent COVID-19 include:

• avoiding contact with those who have or are suspected to have COVID-19
• washing your hands frequently
• improving the air flow and ventilation in your home
• moving activities outdoors whenever possible
• wearing a face covering, such as a mask, or practicing physical distancing, if necessary

People with heart conditions can be at a higher risk of severe COVID-19. Some research has found that preexisting arrhythmia, particularly AFib, may increase the risk of death due to COVID-19.

But most of this research has been conducted in people who were already hospitalized for serious COVID-19. It’s unclear how mild or moderate COVID-19 affects people with arrhythmia.

COVID-19 can also increase the risk of new onset cardiovascular disease, including arrhythmia. As such, it’s important to take steps to prevent developing COVID-19, such as getting vaccinated and washing your hands frequently.