Index of cardiac electrophysiological balance (iCEB) in patients with COVID-19

Aims: We aimed to examine whether there is abnormal value of index of cardiac electrophysiological balance (iCEB=QT/QRS) in patients with confirmed coronavirus disease 2019 (COVID-19), which can predict ventricular arrhythmias (VAs), including non-Torsades de Pointes-like ventricular tachycardia/ventricular fibrillation (non- TdPs-like VT/VF) in low iCEB and Torsades de Pointes (TdPs) in high iCEB. We also investigated low voltage ECG among COVID-19 group. Methods and Results: This is a cross-sectional, single center study with a total of 53 newly diagnosed COVID-19 patients (confirmed with polymerase chain reaction (PCR) test) and 63 age and sex-matched control subjects were included in the study. Electrocardiographic marker of iCEB were calculated manually from 12-lead ECG. Low voltage ECG defined as peak-to-peak QRS voltage less than 5mm in all limb leads and less than 10mm in all precordial leads. Patients with COVID-19 more often had low iCEB, defined as iCEB below 3.24 compared to control group (56.6% vs 11.1%), (OR=10.435;95%CI 4.015 - 27.123;p=0.000). There were no significant association between COVID-19 and high iCEB, defined as iCEB above 5.24 (OR=1.041;95%CI 0.485 - 2.235;p=0.917). There were no significant difference of the number of low voltage ECG between COVID-19 and control groups (15.1% vs 6.3%), (OR=2.622;95%CI 0.743 - 9.257, p=0.123). Conclusion: In this study showed that patients with COVID-19 are more likely to have low iCEB, suggesting that patients with COVID-19 may be proarrhytmic (towards non- TdPs-like VT/VF event), due to the alleged myocardial involvement in SARS-CoV-2 infection.

Evaluation of P wave abnormalities in newly diagnosed COVID-19

Aims: The aim of the current study was to evaluate P wave abnormalities, including prolonged P wave duration, prolonged P wave dispersion (PWD) and abnormal P wave axis (PWA) in newly diagnosed COVID-19 patients. Methods and Results: This is a cross-sectional, single center study with a total of 53 newly diagnosed COVID-19 patients (confirmed with polymerase chain reaction (PCR) test) and 63 age and sex-matched control subjects were included in the study. P wave dispersion, maximum P wave duration, and PWA were calculated manually from 12-lead ECG. Patients with COVID-19 more often had prolonged PWD, defined as PWD ≥ 36 ms compared to control group (37,7% vs 15,9%), (OR=3,212;95%CI 1,34 - 7,70;p=0,007). There were no significant association between COVID-19 and prolonged P wave (defined as maximum P wave duration > 106 ms) (OR=1,446;95%CI 0,454 - 4,6;p=0,531) and abnormal PWA (defined as any value of PWA outside 0 to 75°) (OR=5,061;95%CI 0,548 - 46,74;p=0,115). Conclusion: Our study showed that COVID-19 patients are more likely to have prolonged PWD compared to control patients. However, COVID-19 was not significantly associated with prolonged P wave and abnormal PWA. We believe that initial noninvasive evaluation of PWD may serve as a predictor of atrial arrhytmias often found in COVID-19 patients.