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.