From the Guidelines
Yes, pneumonia can cause atrial flutter, as it creates significant physiological stress on the body that can trigger cardiac arrhythmias, including atrial flutter, especially in elderly patients or those with pre-existing heart conditions. Pneumonia, particularly when severe, leads to inflammation, hypoxemia, and increased metabolic demands that strain the heart, as noted in a study published in Circulation 1. This study found that among 3068 hospitalized patients with pneumonia, 12% developed a cardiovascular event, including cardiac arrhythmias. The infection can directly affect the heart through inflammatory mediators, electrolyte disturbances, and autonomic nervous system activation.
The physical stress of coughing, fever, and respiratory distress further increases cardiac workload, making patients with pneumonia more susceptible to developing atrial flutter. A study published in the American Journal of Respiratory and Critical Care Medicine 1 discussed the complications of pneumonia, including extrapulmonary complications such as cardiac arrhythmias. However, the more recent and higher quality study published in Circulation 1 provides more relevant information on the relationship between pneumonia and cardiac arrhythmias, including atrial flutter.
Key factors that increase the risk of developing cardiac arrhythmias, including atrial flutter, in patients with pneumonia include:
- Older age
- History of heart failure
- Need for mechanical ventilation or vasopressors
- Severity of pneumonia
- Presence of chronic heart disease, chronic kidney disease, tachycardia, septic shock, multilobar pneumonia, hypoalbuminemia, and pneumococcal pneumonia, as identified by Viasus et al in the Circulation study 1.
If a patient with pneumonia develops symptoms like palpitations, dizziness, or worsening shortness of breath, medical evaluation is needed as atrial flutter may require specific treatment with rate control medications, anticoagulation to prevent blood clots, and potentially cardioversion or other rhythm control strategies depending on the clinical situation. Electrocardiographic monitoring is recommended for patients with pneumonia who have at least 6 of the identified risk factors, as suggested by Viasus et al in the Circulation study 1.
From the Research
Association between Pneumonia and Atrial Flutter
- There is evidence to suggest that pneumonia can be associated with the development of atrial fibrillation, a type of arrhythmia that can be related to atrial flutter 2, 3, 4, 5.
- A study published in 2021 found that new-onset atrial fibrillation occurred in 9.9% of patients with pneumococcal pneumonia, with older age, heavy drinking, and severe inflammation being independent risk factors for its development 4.
- Another study published in 2015 found that atrial fibrillation was an independent risk factor for hospital-acquired pneumonia, with an adjusted rate of 25.64% in patients with atrial fibrillation compared to 3.66% in those without 3.
- While the exact relationship between pneumonia and atrial flutter is not explicitly stated in the provided studies, the association between pneumonia and atrial fibrillation suggests that pneumonia may also be related to the development of atrial flutter 2, 4, 5.
Clinical Significance of Atrial Fibrillation in Pneumonia
- Atrial fibrillation in the setting of acute pneumonia is not considered a secondary arrhythmia, but rather a distinct entity that holds a prognostic role similar to that of primary atrial fibrillation 5.
- The development of new-onset atrial fibrillation in patients with pneumonia is associated with higher in-hospital mortality and poorer 6-month survival rates 4.
- The management of atrial fibrillation in patients with pneumonia should follow a guidelines-oriented approach, including the prescription of anticoagulants in patients at thromboembolic risk 5.