Post-SARS-CoV-2 immune response and atrial fibrillation in heart failure patients
O V Stasyshena, O S Sychov, T V Getman, O V Sribna, T V Mikhalieva, A N Solovyan, Y V MogilnitskyAbstract
Introduction
Atrial fibrillation (AF) frequently coexists with heart failure (HF) and significantly worsens its clinical course and prognosis. SARS-CoV-2 infection is associated with persistent systemic inflammation, which may promote atrial electrical instability and increase AF burden, thereby contributing to HF progression.
Purpose
To assess markers of systemic inflammation and SARS-CoV-2-specific immunoglobulin (IgG, IgM) levels in patients with AF and HF depending on a history of coronavirus infection.
Methods
We examined 167 patients with paroxysmal or persistent AF and concomitant heart failure (mean age 62.5 ± 0.09 years) who were in sinus rhythm at the time of evaluation. Among them, 118 patients had a documented history of COVID-19 infection (mean 6.2 ± 0.5 months prior; Group 1), while 49 patients had no history of coronavirus infection (Group 2). Levels of C-reactive protein, IgG and IgM were measured, and AF paroxysm frequency and duration were analyzed.
Results
Patients with prior coronavirus infection demonstrated significantly higher levels of C-reactive protein compared with patients without infection history (5.29 ± 0.025 vs 3.54 ± 0.10 mg/l, p < 0.001). Lower SARS-CoV-2 IgG levels were observed in patients with increased AF paroxysm frequency compared with those without changes in AF burden (7.84 ± 0.41 vs 9.11 ± 0.33 ng/ml, p < 0.05). SARS-CoV-2 IgM levels were not associated with AF paroxysm frequency (p = NS). However, higher SARS-CoV-2 IgM levels were associated with longer AF paroxysm duration (1.07 ± 0.20 vs 0.20 ± 0.11 ng/ml, p < 0.05), whereas SARS-CoV-2 IgG levels were not related to paroxysm duration.
Conclusions
In patients with AF and heart failure, previous SARS-CoV-2 infection is associated with persistent systemic inflammation and increased atrial electrical instability. Higher SARS-CoV-2 IgG levels, reflecting adequate acquired immunity, are linked to a lower AF burden, whereas even mild elevations of SARS-CoV-2 IgM may indicate prolonged arrhythmic episodes. These immune-inflammatory mechanisms may contribute to impaired rhythm control and heart failure progression in the post-COVID period.