Low prevalence of arrhythmias among healthcare workers who recovered from COVID-19

INTRODUCTION The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause multiple cardiologic complications such as myocardial injury, cardiogenic shock and arrhythmias. In patients admitted to an intensive care unit (ICU), sinus tachycardia and atrial fibrillation are the most commonly reported arrhythmias. However, data on the prevalence of arrhythmias after symptomatic SARS-CoV-2 infection is limited. Using 48-hour electrocardiographic (ECG) Holter monitoring, we aimed to analyse the incidence and types of arrhythmias among healthcare workers who recovered from SARS-COV-2 infection. MATERIAL AND METHODS The study involved 34 healthcare workers from the university hospital, who had SARS-CoV-2 infection confirmed by pharyngeal swab up to 4 months before study onset and who did not need an ICU stay due to the illness. Each subject underwent a 48-hour ECG monitoring and completed a questionnaire on the course of the disease. Cardiac magnetic resonance imaging (CMR) was performed and the presence of potential arrhythmias substrate was assessed. RESULTS We recruited 24 women and 10 men (47% were doctors) in the mean age of 37 ± 11 years old who underwent symptomatic SARS-CoV-2 infection, but did not require hospitalization during illness. The mean time from the positive swab test to the start of 48-hour ECG monitoring was 2.9 ± 0.9 months. The most frequently reported (in 100%), though sparse, were supraventricular premature contractions (SVPCs) (mean 46 ± 64 per person/day). Atrial fibrillation or atrial flutter were not recorded, however supraventricular tachycardia (SVT) was found in 18% of subjects, and the range of the highest frequency of SVTs was 124-179 bpm. There were no ventricular tachycardia episodes. Ventricular premature contractions (VPCs) were found in 28% of participants but were usually sparse (mean number per person 98 ± 252/day). Six participants had more than 100 VPCs/day, and in 1 it exceeded 1000/day. No one had QTc interval longer than 438 ms. 48-hour ECG monitoring revealed a tendency towards sinus tachycardia during activity time, however, the daily rhythm modulation was diminished in only 15% of participants. Significantly higher maximal daily heart rate (P <0.05) was observed in 29% of subjects in whom CMR revealed the presence of late gadolinium enhancement (LGE). The presence of LGE or extended T1 and T2 relaxation times from CMR were not predictors of the increased number of VPCs or SVPCs (P >0.05). No significant atrioventricular conduction disturbances were recorded. CONCLUSIONS The prevalence of arrhythmias in the mid-term observation of not-hospitalized COVID-19 survivors is low. During prolonged 48-hour ECG monitoring of healthcare workers, neither life-threatening nor clinically significant arrhythmias were recorded. Therefore, the arrhythmic burden after infection with SARS-CoV-2 should be considered as marginal.

Unusual echocardiographic evidence of hypercoagulation in usual left atrial appendage as the first and only sign of COVID-19.

Coronavirus disease 2019 (COVID-19) is a condition caused by a novel virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease's course ranges from entirely asymptomatic to severely ill patients. Hypercoagulation is often a complication of this disease, worsening the prognosis, which is extremely important in patients at higher risk of thromboembolic events, such as atrial fibrillation (AF), where thrombus formation in the left atrial appendage (LAA) is frequent. LAA could be of various sizes, volumes, and shapes, distinguish several morphologies, from which the WindSock LAA is the most frequent. In contrast, thromboembolic complications occur most frequently in patients with AF and the Cactus LAA. We present a clinical case of a 70-year-old woman with an initial negative real-time polymerase chain reaction (RT-PCR) test for SARS-CoV-2, suspicion of device-related infection after dual pacemaker implantation, AF, and LAA without thrombus in the initial transoesophageal echocardiography (TEE). Despite apixaban treatment, spontaneous restoration of sinus rhythm, and WindSock LAA morphology, the sludge in LAA was diagnosed in control TEE. The patient did not present any typical clinical COVID-19 symptoms but re-checked the RT-PCR test for SARS-CoV-2 infection was positive. The described case presents echocardiographic evidence of hypercoagulation as the first and only feature of SARS-CoV-2 condition besides the usual morphological presentation of the WindSock LAA.