Electrocardiographic Features at Admission and During Hospitalization in Patients with COVID-19

Document Type : Original Article (s)

Authors

1 General Practitioner, Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran

2 Assistant Professor, Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

3 - Professor, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

4 Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

10.48305/jims.v43.i810.0335

Abstract

Background: Besides respiratory complications of SARS-CoV-2, evidence suggests cardiac involvement and its potential role in prognosis. This study aimed to investigate ECG features and the occurrence of arrhythmias associated with disease severity in COVID-19 patients.
Methods: A total of 256 patients diagnosed with SARS-CoV-2 infection were included. Baseline characteristics, clinical examinations, and laboratory tests were evaluated. Electrocardiographic parameters, including PR interval, QRS duration, corrected QT interval (QTc), frequency of bundle branch blocks, and ST-T segment changes, were assessed at admission and during hospitalization. Comparisons were made between critically ill patients and those with less severe disease, as well as between patients with and without ischemic heart disease (IHD) or elevated troponin levels. The incidence of arrhythmic events was also analyzed.
Findings: Critically ill patients were older. Although baseline ECG parameters did not significantly differ by disease severity, PR and QT intervals were significantly prolonged in critically ill patients during hospitalization. Prolonged QTc was also observed in patients with a history of IHD and elevated troponin levels. The most common arrhythmia was atrial fibrillation, with a prevalence of 2.34%. Other abnormal rhythms included junctional rhythm (0.39%), complete heart block (0.39%), and sustained monomorphic ventricular tachycardia (0.39%).
Conclusion: Patients with severe SARS-CoV-2 infection exhibited a higher occurrence of ECG abnormalities, including prolonged PR and QT intervals and an increased occurrence of atrial fibrillation during hospitalization. Furthermore, baseline ECG abnormalities were more frequent in critically ill patients, which may highlight the potential role of ECG findings in early risk assessment and prognosis.

Highlights

Saeide Bahrani: Google Scholar, PubMed

Zahra Teimouri-Jervekani: Google Scholar, PubMed

Keywords

Main Subjects

References

  1. World Health Organization. Estimating mortality from COVID-19: scientific brief, [4 Aug 2020]. Geneva: WHO; 2020.
  2. Nishiga M, Wang DW, Han Y, Lewis DB, Wu JC. COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives. Nat Rev Cardiol 2020;17(9): 543–58.
  3. Clerkin KJ, Fried JA, Raikhelkar J, Sayer G, Griffin JM, Masoumi A, et al. COVID-19 and cardiovascular disease. Circulation 2020; 141(20): 1648–55.
  4. Mehra MR, Desai SS, Kuy S, Henry TD, Patel AN. Cardiovascular disease, drug therapy, and mortality in COVID-19. N Engl J Med 2020; 382: e102.
  5. Majure DT, Gruberg L, Saba SG, Kvasnovsky C, Hirsch JS, Jauhar R, et al. Usefulness of elevated troponin to predict death in patients with COVID-19 and myocardial injury. Am J Cardiol 2020; 138: 100–6.
  6. Tersalvi G, Vicenzi M, Calabretta D, Biasco L, Pedrazzini G, Winterton D. Elevated troponin in patients with Coronavirus Disease 2019 (COVID-19): possible mechanisms. J Card Fail 2020; 26(6): 470–5.
  7. Sandoval Y, Januzzi JL Jr, Jaffe AS. Cardiac troponin for the diagnosis and risk-stratification of myocardial injury in COVID-19: JACC Review Topic of the Week. J Am Coll Cardiol 2020; 76(10): 1244–58.
  8. Poncet A, Gencer B, Blondon M, Gex-Fabry M, Combescure C, Shah D, et al. Electrocardiographic screening for prolonged QT interval to reduce sudden cardiac death in psychiatric patients: a cost-effectiveness analysis. PLoS One 2015; 10(6): e0127213.
  9. Bertini M, Ferrari R, Guardigli G, Malagu M, Vitali F, Zucchetti O, et al. Electrocardiographic features of 431 consecutive, critically ill COVID-19 patients: an insight into the mechanisms of cardiac involvement. Europace 2020; 22(12): 1848–54.
  10. Haseeb S, Gul EE, Çinier G, Bazoukis G, Alvarez-Garcia J, Garcia-Zamora S, et al. Value of electrocardiography in coronavirus disease 2019 (COVID-19). J Electrocardiol 2020; 62: 39–45.
  11. Barman HA, Atici A, Alici G, Sit O, Tugrul S, Gungor B, et al. The effect of the severity of COVID-19 infection on electrocardiography. Am J Emerg Med 2020; 38(12): 2134–40.
  12. Chorin E, Dai M, Shulman E, Wadhwani L, Bar-Cohen R, Barbhaiya C, et al. The QT interval in patients with COVID-19 treated with hydroxychloroquine and azithromycin. Nat Med 2020; 26(6): 808–9.
  13. Ackermann M, Verleden SE, Kuehnel M, Haverich A, Welte T, Laenger F, et al. Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in COVID-19. N Engl J Med 2020; 383(2): 120–8.
  14. Nadkarni GN, Lala A, Bagiella E, Chang HL, Moreno PR, Pujadas E, et al. Anticoagulation, bleeding, mortality, and pathology in hospitalized patients with COVID-19. J Am Coll Cardiol 2020; 76(16): 1815–26.
  15. Davis RC, Hobbs FDR, Kenkre JE, Roalfe AK, Iles R, Lip GYH, et al. Prevalence of atrial fibrillation in the general population and in high-risk groups: the ECHOES study. Europace 2012; 14(11): 1553–9.
  16. Granada J, Uribe W, Chyou P-H, Maassen K, Vierkant R, Smith PN, et al. Incidence and predictors of atrial flutter in the general population. J Am Coll Cardiol 2000; 36(7): 2242–6.
  17. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA 2020; 323(20): 2052–9.
  18. Lippi G, Lavie CJ, Sanchis-Gomar F. Cardiac troponin I in patients with coronavirus disease 2019 (COVID-19): Evidence from a meta-analysis. Prog Cardiovasc Dis 2020; 63(3): 390–1.
  19. Aromolaran AS, Srivastava U, Alí A, Chahine M, Lazaro D, El-Sherif N, et al. Interleukin-6 inhibition of hERG underlies risk for acquired long QT in cardiac and systemic inflammation. PLoS One 2018; 13(12): e0208321.
  20. Miller WT 3rd, Geselowitz DB. Simulation studies of the electrocardiogram. II. Ischemia and infarction. Circ Res 1978; 43(2): 315–23.
  21. Deng Q, Hu B, Zhang Y, Wang H, Zhou X, Hu W, et al. Suspected myocardial injury in patients with COVID-19: Evidence from front-line clinical observation in Wuhan, China. Int J Cardiol 2020; 311: 116–21.
  22. Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020; 5(7): 811–8.
  23. Szekely Y, Lichter Y, Taieb P, Banai A, Hochstadt A, Merdler I, et al. The Spectrum of Cardiac Manifestations in Coronavirus Disease 2019 (COVID-19): a Systematic Echocardiographic Study. Circulation 2020; 142(4): 342–53.
  24. Zheng Y-Y, Ma Y-T, Zhang J-Y, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol 2020; 17(5): 259–60.
  25. Surawicz B, Knilans T. Chou’s electrocardiography in clinical practice. 6th Philadelphia, PA: Elsevier Health Sciences; 2008.
Journal of Isfahan Medical School
Volume 43, Issue 810
2nd Week, June
May and June 2025
Pages 335-345

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History

  • Receive Date: 23 February 2025
  • Accept Date: 01 June 2025

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