Introduction
The global pandemic of coronavirus disease 2019 (COVID-19) has caused more than million infections and hundred thousand deaths.1As of May 18th, 2020, there were more than 4,500,000 patients infected globally with over 300,000 fatalities.The disease is caused by the severe acute respiratory coronavirus 2 (SARS-CoV-2), a single-stranded RNA virus belonging to the family Coronaviridae.2Although the majority of COVID-19 patients (81%) presented with mild illness, more than 15% of the patients developed severe diseases to multi-organ decompensation.3 These critical patients requiring intensive care were usually older and had underlying comorbidities, e.g., coronary artery disease, hypertension, diabetes and cerebrovascular disease.4The severe complications included acute respiratory distress syndrome (ARDS) (29%), acute cardiac injury (12%), and secondary infection (10%).5COVID-19 patients with cardiac injury had a higher incidence of malignant arrhythmias and mortality rate than those without.6The incidence of arrhythmias varies in different studies, ranging from 5.9% to 16.7%.4,6
Atrial fibrillation (AF) is the most common arrhythmias associated with aging and a variety of cardiovascular comorbidities. It is not be surprising that the new-onset or pre-existing AF could be frequently observed in COVID-19 patients. The Italian Ministry of Health reported concurrent AF in 19-22% of COVID-19 patients.7,8In the latest pharmacological trial using remdesivir in 53 hospitalized COVID-19 patients, 3 patients developed new-onset AF (6%).9
The management of AF is complex and includes rhythm and rate control, and prevention of stroke. The COVID-19 pandemic has brought unprecedented and significant challenges in the management of AF patients with COVID-19. Therefore, we review the evidence of COVID-19 and AF from relevant pathophysiology to clinical management, solicit pivotal issues, and provide provisional recommendations.