ABSENCE OF HEART RATE VARIABILITY CHANGE DURING FOLLOW UP AFTER COVID-19 DOESN’T SUGGEST DIRECT CARDIOVASCULAR IMPACT

Objective: To evaluate the need for cardiac monitoring of unselected patients recovered from COVID-19 and to estimate the risk of development of arrhythmias after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Results: Presence of significant pathology detected was rare (one paroxysmal atrial fibrillation in 73-years old woman with dilated left atrium; 71-years old man with atrioventricular blockade with indication for implantation of the pacemaker, when cardiac MRI didn’t find any signs of myocardial inflammation). After evaluation both were not related to previous SARS-CoV-2 infection.

During one year follow up after COVID-19 infection there was no change in heart rate variability evaluated by SDNN (V1 vs V3 156.6±40.6 vs 156,0±38.0; p=0.855), rMSSD (V1: 33±13.95 to 30.6±12.89; p=0.175) and triangle (V1: 28.5±7.8 to 29.5±8.8; p=0.488). Dividing heart rate oscillations into low-frequency (LF), and high-frequency (HF) bands, we have found statistically significant changes between V1 a V3 for LF (718±433.7 to 646±361; p=0.024) and HF (341.5±335 to 268.0±266; p=0.032). These parameters are mostly affected by breathing rate and are representing possible autonomic dysregulation (HF/LF ratio).

Conclusion: Despite many information regarding cardiac impairment of SARS-CoV2 our study does not suggest increased risk of development of arrhythmias after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) even in a population with high proportion of ongoing symptomatology. Some findings may suggest autonomic dysfunction after COVID-19. Based on our results the routine ECG monitoring is currently not recommended after COVID-19 recovery.