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World J Crit Care Med. Dec 9, 2023; 12(5): 236-247
Published online Dec 9, 2023. doi: 10.5492/wjccm.v12.i5.236
New-onset atrial fibrillation among COVID-19 patients: A narrative review
Fahimeh Talaei, Akshat Banga, Amanda Pursell, Ann Gage, Namratha Pallipamu, Amith Reddy Seri, Ramesh Adhikari, Rahul Kashyap, Salim Surani
Fahimeh Talaei, Department of Critical Care Medicine, Mayo Clinic, Phoenix, AZ 85054, United States
Akshat Banga, Department of Internal Medicine, Sawai Man Singh Medical College, Jaipur 302004, India
Amanda Pursell, Internal Medicine, Tristar Centennial Medical Center, TriStar Division, HCA Healthcare, Nashville, TN 37203, United States
Ann Gage, Cardiology, TriStar Centennial Medical Center, TriStar Division, HCA Healthcare, Nashville, TN 37203, United States
Namratha Pallipamu, Department of Medicine, Siddharta Medical College, Vijayawada 520008, Andhra Pradesh, India
Amith Reddy Seri, Department of Internal Medicine, Mclaren Regional Medical Center, Flint, MI 48532, United States
Ramesh Adhikari, Department of Internal Medicine, Franciscan Health, Lafayette, IN 46237, United States
Rahul Kashyap, Salim Surani, Department of Anaesthesiology & Critical Care Medicine, Mayo Clinic, Rochester, MN 55902, United States
Rahul Kashyap, Department of Research, WellSpan Health, York, PA 17401, United States
Salim Surani, Department of Medicine & Pharmacology, Texas A&M University, College Station, TX 77843, United States
Author contributions: Talaei F and Kashyap R contributed to the conceptualization and methodology of this manuscript; Banga A, Adhikari R, and Kashyap R involved in the validation of this study; Talaei F, Banga A, Pursell A, Adhikari R, and Kashyap R participated in the formal analysis; Talaei F, Banga A, Pallipamu N, and Kashyap R investigated the article; Talaei F, Banga A, Pursell A, Gage A, Pallipamu N, Seri AR, Adhikari R, and Surani S contributed to the writing-original draft preparation of this study; Talaei F, Banga A, Pursell A, Seri AR, Adhikari R, Kashyap R, and Surani S involved in the writing-review and editing of this manuscript; Adhikari R, Kashyap R and Surani S participated in project administration.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Salim Surani, FCCP, MD, MHSc, Academic Editor, Professor, Department of Medicine & Pharmacology, Texas A&M University, 400 Bizzell Street, College Station, TX 77843, United States. srsurani@hotmail.com
Received: May 30, 2023
Peer-review started: May 30, 2023
First decision: August 2, 2023
Revised: August 20, 2023
Accepted: September 11, 2023
Article in press: September 11, 2023
Published online: December 9, 2023
Processing time: 190 Days and 9.9 Hours
Abstract

Over the last three years, research has focused on examining cardiac issues arising from coronavirus disease 2019 (COVID-19) infection, including the emergence of new-onset atrial fibrillation (NOAF). Still, no clinical study was conducted on the persistence of this arrhythmia after COVID-19 recovery. Our objective was to compose a narrative review that investigates COVID-19-associated NOAF, emphasizing the evolving pathophysiological mechanisms akin to those suggested for sustaining AF. Given the distinct strategies involved in the persistence of atrial AF and the crucial burden of persistent AF, we aim to underscore the importance of extended follow-up for COVID-19-associated NOAF. A comprehensive search was conducted for articles published between December 2019 and February 11, 2023, focusing on similarities in the pathophysiology of NOAF after COVID-19 and those persisting AF. Also, the latest data on incidence, morbidity-mortality, and management of NOAF in COVID-19 were investigated. Considerable overlaps between the mechanisms of emerging NOAF after COVID-19 infection and persistent AF were observed, mostly involving reactive oxygen pathways. With potential atrial remodeling associated with NOAF in COVID-19 patients, this group of patients might benefit from long-term follow-up and different management. Future cohort studies could help determine long-term outcomes of NOAF after COVID-19.

Keywords: COVID-19; SARS-CoV-2; New-onset atrial fibrillation; Atrial fibrillation

Core Tip: In this literature review, we have observed resemblances between the fundamental pathophysiology of coronavirus disease 2019 (COVID-19)-related new-onset atrial fibrillation (NOAF) and the mechanisms proposed for the persistence of AF, particularly those involving oxidative stress and reactive oxygen species. The mechanisms responsible for the development of AF following a COVID-19 infection could potentially contribute to atrial remodeling, further perpetuating AF. However, while short-term outcomes of COVID-19-related NOAF have been well-studied, as we transition into an endemic era of COVID-19, there is a need for more research to investigate the long-term outcomes of patients who develop NOAF after COVID-19 infection.