Whether and what abnormalities we find in ECG records and 24-hour Holter ECG in patients after COVID-19 without hospitalization with cardiac damage
Authors: Chudzik M , Babicki M , Kapusta J , Kolat D , Kaluzinska-Kolat Z , Mastalerz-Migas A , Jankowski P 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.
Cardiac arrhythmias and cardiac damage (CD) are more common in hospitalized patients with COVID-19. Many studies have shown that arrhythmias are an independent risk factor for death and the course of COVID-19 in these patients. However, there are no publications on the impact of the SARS CoV-2 on patients with a domestic course of COVID-19 without a previous history of cardiovascular disease. The aim of the study was to assess whether and what arrhythmias occur in patients in the early period after the course of COVID-19 without hospitalisation and to assess which of them may be predictors of heart damage after COVID-19.

Methods
In patients, in the post-COVID period (mean 12 ± 6 weeks) a standard 12-lead ECG (ECG) and 24-h Holter ECG (Holter) were performed.
Following parameters were analysed: 1. in ECG: mean heart rate (mHR); PQ interval (PQ), QRS duration (QRSd); corrected QT interval (QTc); atrial fibrillation (AF); inappropriate sinus tachycardia (ITS), QRS duration &gt; 120ms (QRS&gt;120); LBBB, RBBB, QRS fragmentation (QRSf); STT wave abnormalities (STTabn); presence of premature supraventricular (SVES) and ventricular (VES) complexes; 2. in 24-h Holter ECG: sinus tachycardia (STach), new atrial fibrillation (AFHolter), SVES &gt; 1000/24h (SVES&gt;1000); supraventricular tachycardia (TSV), VES &gt; 1000/24h (VES&gt;1000), Couplet VES (VEScouplet), non-sustained ventricular tachycardia (nsVT); ventricular tachycardia (VT), block A-V 2nd typ 2 and/or block A-V 3rd grade (AVdist). Cardiac damage (CardD) was defined as EF&lt;50% and/or any contraction abnormalities in ECHO and/or MRI examination. Patients were divided into two groups depending on the cardiac damage: Gr 1 without CardD and Gr 2 with CardD. Next ECG and Holter parameters were compared between both groups.

Results
A total of 1032 patients, (64% women and 36% men), mean age was 47.8± 16.5 were included in the analysis, of whom 91 pts (9,28%) met the cardiac damage criteria. The most frequent ECG abnormalities QRS fragmentations in 17,3% pts – noted in 17,3%. In no one pts VT and or VF was found. Comparison between groups in analysed parameters are shown IN Table 1 and Table 2
Multivariate regression analysis showed that: age (OR 1.02, 95%Cl 1.00-1.104; p=0.028), LBBB (OR 30.82; 95%Cl 1.99-475.80; p=0,014), VES&gt;1000/24h (OR 7.97; 95%Cl 1.68 -37.78; p=0,008), nsVT (OR 6.20; 95%Cl 1.22-31.62; p=0,028) were associated with a higher risk of cardiac injury in the post COVID period
However female were lower risk of cardiac damage (OR 0,27, 95%Cl 0.14-0.41; p&lt;0.001)

Conclusions
Based on the obtained results, it can be concluded that the most common cardiac arrhythmias which predict cardiac damage in patients in the early period after the course of COVID-19 without hospitalization were LBBB, ventricular extrasystoles VES&gt;1000/24h and non-sustained ventricular tachycardia. In addition, age (elderly people) and sex (male) predispose to myocardial damage after COVID-19.