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Aims:  Thromboembolic events, including stroke, are typical complications of COVID-19. Whether arrhythmias, frequently described in severe COVID-19, are disease-specific and thus promote strokes is unclear. We investigated the occurrence of arrhythmias and stroke during rhythm monitoring in critically ill patients with COVID-19, compared with severe pneumonia of other origins.   Methods and Results:  This retrospective study included 120 critically ill patients requiring mechanical ventilation in three European tertiary hospitals, including  n  =60 COVID-19, matched according to risk factors for the occurrence of arrhythmias in  n  = 60 patients from a retrospective consecutive cohort of severe pneumonia of other origins. Arrhythmias, mainly atrial fibrillation (AF), were frequent in COVID-19. However, when compared with non-COVID-19, no difference was observed with respect to ventricular tachycardias (VT) and relevant bradyarrhythmias (VT 10.0 vs. 8.4 %,  p  =  ns  and asystole 5.0 vs. 3.3%,  p  =  ns ) with consequent similar rates of cardiopulmonary resuscitation (6.7 vs. 10.0%,  p  =  ns ). AF was even more common in non-COVID-19 (AF 18.3 vs. 43.3%,  p  =  0.003 ; newly onset AF 10.0 vs. 30.0%,  p  =  0.006 ), which resulted in a higher need for electrical cardioversion (6.7 vs. 20.0%,  p  =  0.029 ). Despite these findings and comparable rates of therapeutic anticoagulation (TAC), the incidence of stroke was higher in COVID-19 (6.7.% vs. 0.0,  p  =  0.042 ). These events also happened in the absence of AF (50%) and with TAC (50%).   Conclusions:  Arrhythmias were common in severe COVID-19, consisting mainly of AF, yet less frequent than in matched pneumonia of other origins. A contrasting higher incidence of stroke independent of arrhythmias also observed with TAC, seems to be an arrhythmia-unrelated disease-specific feature of COVID-19.

Higher Incidence of Stroke in Severe COVID-19 Is Not Associated With a Higher Burden of Arrhythmias: Comparison With Other Types of Severe Pneumonia