PACE - manuscript for review
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hemodynamic changes related to atrial tachyarrhythmia are unique to COVID infection and may represent a phenomenon seen in all individuals with severe ARDS. Studies have shown that prone positioning in individuals with ARDS improves ventilation and improves right ventricular ejection fraction,28 left ventricular preload28, 29 and cardiac output.30, 31 Thus, prone positioning may represent another potential approach to attenuate the hemodynamic effects of atrial tachyarrhythmia in COVID-19, an effect which could conceivably contribute to the survival benefit shown with this agent in ARDS.
While the specific mechanism of myocardial injury in COVID infection remains to be defined, individuals susceptible to atrial arrhythmias and myocardial injury may be more likely to develop severe manifestations of viral infection.32 It remains to be seen whether early intervention of atrial tachyarrhythmia in these individuals will mitigate the severe clinical course of the disease. Limitations
There are several significant limitations of our study. First, this is a retrospective study from a single tertiary referral center which likely over represents individuals with severe manifestations of COVID-19 infection. Secondly, our study has a small sample size with a comparative group that does not perfectly match our COVID+ population. However, our COVID+