The COVID-19 pandemic continues to be an ongoing health crisis affecting over 49 million patients in the US. Currently, 3 vaccines have been authorized for use by the US FDA for preventing COVID-19 infection. Although data are accumulating on rare reports of myocarditis, there is little data on atrial fibrillation (AF) after COVID-19 vaccination. In the initial randomized clinical trial of the Moderna vaccine, the incidence of AF was reported to be <0.1%, and balanced between the vaccine and placebo groups; but the cohort was relatively young (75% were < 65 years old).
We sought to assess the associated risk of AF with COVID-19 vaccination.
We analyzed data from Vaccine Adverse Event Reporting System (VAERS) database, which had categorized self-reported occurrence of AF along with major complications.
Of the total 14,693 individuals who had received at least 1 dose of COVID-19 vaccine and had also reported at least 1 adverse event in VAERS, 23 (0.16%) participants had reported the occurrence of new-onset AF. Of these 23 individuals (mean age = 76.6 ± 15.7 years; M/F = 14 [61%] / 9 [39%]), 10 (43.5%) had received the Moderna vaccine (mRNA-1273) and 13 (56.5%) had received the Pfizer-BioNTech vaccine. The timing of AF onset after the administration of vaccine dose ranged from 3 hours to 14 days. In 15 of the 23 patients, new-onset AF was the primary reason necessitating emergency room visit. Of these 23 individuals, one had a stroke, and another had a transient ischemic attack.
The temporal association of AF with COVID-19 vaccine administration suggest that there may indeed be a transient increase in AF post-vaccination, albeit at a seemingly low rate. This might reflect a transiently elevated proinflammatory state in conjunction with presence of an underlying electrical and structural substrate. The apparent infrequent nature of development of AF suggests that the vaccine should not be withheld because of concern about developing AF. On the other hand, it seems prudent to i) treat post-vaccine AF conservatively as a potentially reversible event (unless the AF persists late [> 1 month] after vaccination), and ii) inform patients with a history of AF that the hyper-inflammatory state associated with COVID-19 vaccination (as can occur with any vaccine) might transiently trigger AF.
© 2022 Published by Elsevier Inc.