Automated left atrial strain analysis for predicting new-onset atrial fibrillation in severe hypoxemic COVID-19 pneumonia: A prospective study

Introduction Atrial fibrillation (AF) is the most documented arrhythmia in COVID-19 pneumonia. Left atrial (LA) strain analysis, assessing LA contractility have been associated with the development of new-onset atrial fibrillation (NOAF) in several clinical situations. We aimed to assess the diagnostic ability of LA strain parameters to predict NOAF in patients with severe hypoxemic COVID-19 pneumonia. Method We conducted a prospective single center study at Amiens Hospital University ( NCT04354558 ). The population study was composed of adult patients with a severe or critical Covid-19 pneumonia in sinus rhythm at inclusion. Transthoracic echocardiography was performed within 48 hours of admission. LA strain analysis was performed by an automated software. The following LA strain parameters were recorded: LA strain during reservoir phase (LASr), LA strain during conduit phase (LAScd) and LA strain during contraction phase (LASct). The primary endpoint was the occurrence of NOAF during the intensive care unit (ICU) stay. Results From March 2020 to February 2021, 79 patients were included. Sixteen patients (18%) developed NOAF in ICU. LAScd and LASr were significantly reduced in the NOAF group compared to the other group (8.1[6.3-10.9] vs. 17.2[5.0-10.2]%; P   11% (log rank test P value  Fig. 1 ). Conclusion In patients with severe hypoxemic COVID-19 pneumonia, LAScd ≤ 11% at admission is a strong risk factor of NOAF development during critical care.