Preexisting Arrhythmia and COVID-19: Risks, Treatment, and Prevention
Explore the complex interaction between preexisting arrhythmias and COVID-19, including risks, emerging treatments, and vaccine guidance.
Arrhythmias—disorders that cause the heart to beat too quickly, too slowly, or irregularly—can significantly complicate a person’s risk when faced with COVID-19. For those living with preexisting heart rhythm disorders, especially atrial fibrillation (AFib), the pandemic raised unique challenges and heightened health concerns. This article examines how preexisting arrhythmias intersect with COVID-19, potential risks, new onset arrhythmias due to the virus, implications for vaccination, and strategies for staying healthy.
Understanding Arrhythmia: Types and Basics
Arrhythmias are broadly categorized based on their location and speed:
- Atrial arrhythmias: Begin in the upper chambers of the heart (atria). The most common is atrial fibrillation (AFib), causing a rapid and irregular heartbeat.
- Ventricular arrhythmias: Originate in the lower chambers (ventricles) and can be more dangerous.
- Bradyarrhythmias: Result in a slower than normal heart rhythm.
Symptoms can range from mild palpitations and occasional dizziness to severe chest pain, shortness of breath, or sudden cardiac arrest. For many, arrhythmia is a manageable chronic condition, but the presence of COVID-19 can alter that risk profile.
How COVID-19 Might Affect People with Preexisting Arrhythmia
Research shows that having a preexisting arrhythmia—especially AFib—increases the risk of severe outcomes if you contract COVID-19. Studies have revealed the following associations:
- Higher risk of death from COVID-19 among hospitalized patients with preexisting AFib.
- Increased likelihood of intensive care unit (ICU) admission and the need for mechanical ventilation compared to those without arrhythmia.
- Greater chance of repeat hospitalization due to complications.
For example, a 2021 study found that people with AFib who were already taking blood clot-preventing medications faced a lower risk of death after contracting COVID-19. This is significant since both COVID-19 and certain arrhythmias, especially AFib, increase the risk of dangerous blood clots.
Why Does Arrhythmia Elevate COVID-19 Risk?
Several intertwined mechanisms make people with arrhythmia more vulnerable:
- Direct viral infection of heart tissue: SARS-CoV-2 may infect and damage heart cells or disrupt electrical signals.
- Body-wide inflammation: Infection triggers inflammation that can destabilize heart rhythm and weaken heart tissue.
- Increased risk of blood clots: COVID-19 itself is a pro-coagulant state, compounding the clot risk in arrhythmia patients.
- Low blood oxygen (hypoxia): Compromised lung function from COVID-19 can deprive the heart of oxygen, triggering arrhythmic events.
- Electrolyte imbalances and dehydration: Fevers, sweating, and reduced food/fluid intake during illness can disturb critical electrolyte levels needed for heart rhythm stability.
It’s worth noting that most research to date focuses on hospitalized COVID-19 cases, so it’s less certain whether people with mild COVID-19 and arrhythmia face similar risks.
Can COVID-19 Cause Arrhythmia in Those Without a Heart Condition?
COVID-19 is capable of triggering arrhythmias even in people with no prior history of heart rhythm problems. Multiple studies have documented arrhythmia onset in patients hospitalized with COVID-19:
- One large study found that about 18% of hospitalized COVID-19 patients developed an arrhythmia during their illness.
- Atrial arrhythmias were the most frequently observed, followed by ventricular arrhythmias and bradyarrhythmias.
- Those who developed arrhythmias typically had additional risk factors, such as high blood pressure, diabetes, or heart failure.
- Arrhythmia in the context of COVID-19 is strongly associated with increased morbidity and mortality.
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Case studies also report increased rates of new-onset AFib in hospitalized COVID-19 patients. Even among people who were not hospitalized, the long-term risk of cardiovascular complications—including arrhythmia—remains elevated for at least one year after recovery from COVID-19.
Other Long-Term Heart Risks After COVID-19
Beyond arrhythmia, COVID-19 has been associated with increased long-term risk of complications such as:
- Coronary artery disease
- Myocarditis (heart muscle inflammation) and pericarditis (inflammation around the heart)
- Serious blood clots (venous thromboembolism)
- Heart failure
- Heart attacks and strokes (including transient ischemic attack)
Treatment Approaches: Managing Arrhythmia and COVID-19
For individuals with preexisting arrhythmias who contract COVID-19, effective management involves both preemptive and responsive strategies:
- Continue heart medications as prescribed (especially blood thinners and antiarrhythmics). Consult your doctor before making any changes.
- Monitor for signs of heart distress, such as palpitations, chest pain, severe shortness of breath, or fainting.
- If hospitalized:
- Frequent cardiac monitoring, especially for those needing ICU care
- Management of electrolyte imbalances and dehydration
- Prevention and treatment of blood clots
- Adjustment of medications as needed, especially if COVID-19 treatments prolong the QT interval or interact with arrhythmia drugs
Patients should also maintain overall heart health by controlling blood pressure, blood sugar, and cholesterol, as well as following up regularly with their cardiology team.
COVID-19 Vaccination: Is It Safe for People with Arrhythmia?
The COVID-19 vaccines are considered safe for people with preexisting arrhythmias, including AFib. In fact, major cardiology organizations such as the American Heart Association strongly recommend that people with arrhythmia receive COVID-19 vaccination due to their elevated risk of severe COVID-19 complications.
Common vaccine side effects are generally mild and short-lived:
- Pain, redness, or swelling at the injection site
- Fatigue
- Fever or chills
- Muscle aches and pain
- Headache
- Nausea
Severe reactions (such as life-threatening allergic reactions or heart inflammation) after vaccination remain extremely rare. For people with arrhythmia, the benefits of vaccination—including a reduced risk of hospitalization, intensive care, and death—far outweigh the potential risks.
Extra Precautions for Heart Rhythm Patients
- Make sure your vaccination status is current, including recommended boosters.
- Discuss any vaccine concerns with your cardiologist, particularly if you have an implanted cardiac device or recent episodes of heart rhythm instability.
- Monitor symptoms after vaccination; seek medical attention for chest pain, new palpitations, or severe allergic reactions.
Preventing COVID-19: Protective Measures for Those with Arrhythmias
In addition to vaccination, heart patients should continue to practice everyday precautions to minimize COVID-19 risk:
- Avoid close contact with people who are sick or have symptoms.
- Practice frequent handwashing with soap and water, or use sanitizer when handwashing is unavailable.
- Improve indoor ventilation by opening windows or using air purifiers.
- Move activities outdoors whenever possible.
- Consider wearing a mask or practicing physical distancing, especially in crowded indoor settings or during surges in community cases.
Table: Key Considerations for Arrhythmia and COVID-19
| Scenario | Main Risks | Recommended Actions |
|---|---|---|
| Preexisting arrhythmia + COVID-19 |
|
|
| No heart condition + COVID-19 |
|
|
| COVID-19 vaccination in arrhythmia patients |
|
|
Frequently Asked Questions (FAQs)
Is it safe to receive the COVID-19 vaccine if I have an arrhythmia?
Yes. The COVID-19 vaccine is considered safe for those with preexisting arrhythmias such as AFib. The benefits of vaccination—protection against severe disease, hospitalization, and death—far exceed any potential risks. Serious side effects are rare, and most people experience only mild, short-term symptoms.
Can having COVID-19 cause long-term heart rhythm problems?
There is growing evidence that COVID-19 can increase the risk of new arrhythmias and related cardiac complications for up to a year after recovery, even in individuals not hospitalized for their infection. Monitoring for symptoms such as palpitations and regular cardiovascular checkups are advised.
What should I do if I have an arrhythmia and develop COVID-19 symptoms?
Contact your healthcare provider promptly. Continue your prescribed heart medications unless instructed otherwise, monitor your symptoms closely, and seek emergency care for severe chest pain, breathing difficulties, or fainting. Early intervention can help prevent serious complications.
How does COVID-19 impact long-term heart health?
COVID-19 is associated with an increased risk of cardiovascular events—including arrhythmia, blood clots, coronary artery disease, and heart attacks—for a year or more after infection. The risk is highest among those with severe illness or existing heart disease, but can affect previously healthy individuals as well.
Takeaway: What People with Arrhythmia Should Know About COVID-19
- Individuals with arrhythmias are at increased risk of severe COVID-19 complications and should use all available protective measures.
- Vaccination is a key defense and is strongly recommended for all heart patients, including those with AFib or other rhythm abnormalities.
- New onset arrhythmias can occur in people with no heart history after COVID-19; ongoing monitoring is important.
- Continue regular care with your cardiology team and communicate promptly about any new or worsening symptoms.
By maintaining medications, staying up to date on vaccinations, and practicing consistent health precautions, people with arrhythmia can lower their risk of complications and achieve better outcomes, even in the era of COVID-19.
References
- https://www.healthline.com/health/heart-health/preexisting-arrhythmia-and-covid
- https://pmc.ncbi.nlm.nih.gov/articles/PMC8632592/
- https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1093053/full
- https://www.healthline.com/health/preexisting-condition-definition
- https://www.ahajournals.org/doi/10.1161/CIR.0000000000001290
- https://pmc.ncbi.nlm.nih.gov/articles/PMC10711544/
- https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.122.008942
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