History of COVID-19 as a Risk Factor for Cardiac Arrhythmias: A Case-Control Study

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was responsible for the coronavirus disease 2019 (COVID-19) pandemic and generated high morbidity and mortality rates worldwide, as well as several sequelae that persist and need to be evaluated. The aim of this study was to evaluate the association between a history of COVID-19 infection and the occurrence of cardiac arrhythmias in outpatients from a private clinic in Arequipa. Methods: We conducted a retrospective, analytical, unmatched case control study in a private cardiology clinic in Arequipa, Peru. A total of 252 adult patients who underwent 24-h Holter monitoring between October and December 2023 were included. Cases were defined as patients with documented cardiac arrhythmias; controls had no arrhythmic findings. The main exposure was a confirmed history of COVID-19. Age, sex, and additional Holter findings were also analyzed. Logistic regression was used to estimate crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs), adjusting for age and sex. Results: Of the total sample, 68 patients were classified as cases and 184 as controls. A history of COVID-19 was more frequent among cases (70.6%) than among controls (50.5%) (P = 0.004). In unadjusted analysis, patients with prior COVID-19 had more than twice the odds of presenting arrhythmias (OR: 2.35; 95% CI: 1.29-4.26; P = 0.005). After adjusting for age and sex, the association remained statistically significant (OR: 2.12; 95% CI: 1.10-4.11; P = 0.025). Conclusion: A prior history of COVID-19 was significantly associated with increased odds of cardiac arrhythmias. These findings highlight the importance of structured cardiac evaluation in patients with prior SARS-CoV-2 infection.