COVID-19 Tied to a Wide Range of ECG Findings

By Reuters Staff

November 11, 2021

NEW YORK (Reuters Health) - It's now clear that COVID-19 infection, while largely a respiratory illness, has a number of cardiac manifestations that include myocardial infarction, myocarditis and various patterns of changes observed on electrocardiograms.

In a new report in Cardiac Electrophysiology Clinics, Dr. Luigi Di Biase of Montefiore-Einstein Center for Heart & Vascular Care in New York and colleagues review the electrocardiographic findings that have been described to date in patients with COVID-19, as well as possible mechanisms contributing to these findings.

Of note, they say clinicians "should be cognizant of some of the reported ECG changes, such as abnormal QRS axis in nearly 20% of patients, conduction abnormalities in approximately 20%, atrioventricular block in about 2.5%, and premature beats in nearly 10% of patients."

"ST and T wave changes in COVID-19 patients can be due to myocardial infarction or myocardial injury secondary to myocarditis, inflammatory responses, or microthrombi, and should therefore be interpreted in the correct clinical context since they can be associated with illness severity and mortality," they advise.

They note that QTc-interval changes have been "extensively" studied and they suggest baseline and follow-up ECG for QTc monitoring in hospitalized patients with COVID-19.

Clinically significant QTc prolongation can be defined as QTc of 500 ms or greater with a normal QRS interval; 550 ms or greater if QRS is 120 ms or greater; or QTc increase of 60 ms or greater from baseline.

Dr. Di Biase and colleagues also note that nearly 9.3% of patients admitted with COVID-19 infection have arrhythmias, most commonly atrial fibrillation.

"Arrhythmias can be a sign of myocardial injury and increased disease severity, and the treatment focus should be on the underlying infection and any potential triggers," the authors advise.

"Knowledge of these electrocardiographic features, paired with patients' clinical status, cardiac imaging findings, and cardiac biomarkers can assist clinicians in accurately assessing and tailoring care through an understanding of the underlying disease processes," Dr. Di Biase and colleagues conclude.

This research had no funding.

SOURCE: Cardiac Electrophysiology Clinics, online October 30, 2021.