Using Machine Learning Algorithms to Determine the Post-COVID State of a Person by Their Rhythmogram.

This study introduces a novel method for detecting the post-COVID state using ECG data. By leveraging a convolutional neural network, we identify "cardiospikes" present in the ECG data of individuals who have experienced a COVID-19 infection. With a test sample, we achieve an 87 percent accuracy in detecting these cardiospikes. Importantly, our research demonstrates that these observed cardiospikes are not artifacts of hardware-software signal distortions, but rather possess an inherent nature, indicating their potential as markers for COVID-specific modes of heart rhythm regulation. Additionally, we conduct blood parameter measurements on recovered COVID-19 patients and construct corresponding profiles. These findings contribute to the field of remote screening using mobile devices and heart rate telemetry for diagnosing and monitoring COVID-19.

Cardiovascular Safety of Hydroxychloroquine-Azithromycin in 424 COVID-19 Patients.

Background and Objectives: Hydroxychloroquine (HCQ) combined with azithromycin (AZM) has been widely administered to patients with COVID-19 despite scientific controversies. In particular, the potential of prolong cardiac repolarization when using this combination has been discussed. Materials and Methods: We report a pragmatic and simple safety approach which we implemented among the first patients treated for COVID-19 in our center in early 2020. Treatment contraindications were the presence of severe structural or electrical heart disease, baseline corrected QT interval (QTc) > 500 ms, hypokalemia, or other drugs prolonging QTc that could not be interrupted. Electrocardiogram and QTc was evaluated at admission and re-evaluated after 48 h of the initial prescription. Results: Among the 424 consecutive adult patients (mean age 46.3 ± 16.1 years; 216 women), 21.5% patients were followed in conventional wards and 78.5% in a day-care unit. A total of 11 patients (2.6%) had contraindications to the HCQ-AZ combination. In the remaining 413 treated patients, there were no arrhythmic events in any patient during the 10-day treatment regimen. QTc was slightly but statistically significantly prolonged by 3.75 ± 25.4 ms after 2 days of treatment (p = 0.003). QTc prolongation was particularly observed in female outpatients <65 years old without cardiovascular disease. Ten patients (2.4%) developed QTc prolongation > 60 ms, and none had QTc > 500 ms. Conclusions: This report does not aim to contribute to knowledge of the efficacy of treating COVID-19 with HCQ-AZ. However, it shows that a simple initial assessment of patient medical history, electrocardiogram (ECG), and kalemia identifies contraindicated patients and enables the safe treatment of COVID-19 patients with HCQ-AZ. QT-prolonging anti-infective drugs can be used safely in acute life-threatening infections, provided that a strict protocol and close collaboration between infectious disease specialists and rhythmologists are applied.

Feasibility of antenatal ambulatory fetal electrocardiography: a systematic review.

BACKGROUND: Antenatal fetal heart rate (FHR) monitoring is currently limited by hospital-based accessibility as well as the availability of relevant equipment and expertise required to position device electrodes. Ambulatory FHR monitoring in the form of noninvasive fetal electrocardiography (NIFECG) is currently an area of research interest, particularly during the era of the COVID-19 pandemic, and the potential to improve maternity care and reduce hospital attendances need to be evaluated. OBJECTIVES: To assess the feasibility, acceptability, and signal success of ambulatory NIFECG monitoring and identify research areas required to facilitate clinical utilization of this method of monitoring. METHODS: Medline, EMBASE, and PubMed databases were searched from January 2005 to April 2021 using terms relevant to antenatal ambulatory or home NIFECG. The search was compliant with PRISMA guidelines, and was registered with the PROSPERO database (CRD42020195809). All studies reporting the clinical utilization of NIFECG inclusive of its use in the ambulatory setting performed in the antenatal period, human studies, and those in the English language were included. Those reporting novel technological methods and electrophysiological algorithms, satisfaction surveys, intrapartum studies, case reports and reviews, and animal studies were excluded. Study screening and data extraction were conducted in duplicate. Risk of bias was appraised using the Modified Downs and Black tool. Due to the heterogeneity of the reported findings, a meta-analysis was not feasible. RESULTS: The search identified 193 citations, where 11 studies were deemed eligible for inclusion. All studies used a single NIFECG system with a duration of monitoring ranging from 5.6 to 21.4 h. Predefined signal acceptance threshold ranged from 34.0-80.0%. Signal success in the study populations was 48.6-95.0% and was not affected by maternal BMI. Good signals were achieved in the 2nd trimester, but less so in the early 3rd trimester. NIFECG was a well-accepted method of FHR monitoring, with up to 90.0% of women's satisfaction levels when worn during outpatient induction of labor. Placement of the acquisition device needed input from healthcare staff in every report. CONCLUSIONS: Although there is evidence for the clinical feasibility of ambulatory NIFECG, the disparity in the literature limits the ability to draw firm conclusions. Further studies to establish repeatability and device validity, whilst developing standardized FHR parameters and set evidence-based standards for signal success for NIFECG are required to ascertain the clinical benefit and potential limitations of ambulatory outpatient FHR monitoring.

Pediatric Cardiac Emergencies: When to Worry and When to Reassure.

Cardiac symptoms are a frequent reason for pediatric patients to present to the emergency department. As stressful as these visits can be for both parents and inexperienced providers, many of these symptoms may have a benign explanation, and recognition of red flags are of the utmost importance to provide optimal care. In this article, we present four clinical scenarios that have a cardiac etiology and are common to the pediatric emergency department. In addition to highlighting differential diagnoses, we discuss important red flags, key signs, and findings on physical examination that should not be missed. A brief review of important workup and management is also discussed. Lastly, we review common electrocardiogram pearls and pitfalls important for the ordering provider to recognize. In this article, we hope to provide guidance on when to provide reassurance and when to refer to a pediatric cardiologist for evaluation. [Pediatr Ann. 2023;52(4):e128-e134.].

COVID-19-associated Brugada pattern electrocardiogram: Systematic review of case reports.

AIMS: To summarize published case reports of patients diagnosed with coronavirus disease 2019 (COVID-19) and Brugada pattern electrocardiogram (ECG). METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist were followed. A literature search was conducted using PubMed, EMBASE, and Scopus up until September 2021. The incidence, clinical characteristics, and management outcomes of COVID-19 patients with a Brugada pattern ECG were identified. RESULTS: A total of 18 cases were collected. The mean age was 47.1 years and 11.1% were women. No patients had prior confirmed diagnosis of Brugada syndrome. The most common presenting clinical symptoms were fever (83.3%), chest pain (38.8%), shortness of breath (38.8%), and syncope (16.6%). All 18 patients presented with type 1 Brugada pattern ECG. Four patients (22.2%) underwent left heart catheterization, and none demonstrated the presence of obstructive coronary disease. The most common reported therapies included antipyretics (55.5%), hydroxychloroquine (27.7%), and antibiotics (16.6%). One patient (5.5%) died during hospitalization. Three patients (16.6%) who presented with syncope received either an implantable cardioverter defibrillator or wearable cardioverter defibrillator at discharge. At follow-up, 13 patients (72.2%) had resolution of type 1 Brugada pattern ECG. CONCLUSION: COVID-19-associated Brugada pattern ECG seems relatively rare. Most patients had resolution of the ECG pattern once their symptoms have improved. Increased awareness and timely use of antipyretics is warranted in this population.

Wellens' syndrome following severe COVID-19 infection, an innocent coincidence or a deadly association: two case reports.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has been associated with late-onset cardiovascular complications primarily due to a hypercoagulable state. Its association with Wellens' syndrome, which reflects a stenosis in the proximal left anterior descending coronary artery, is not well established. We present two cases diagnosed with this syndrome following their COVID-19 acute phase despite taking adequate anticoagulation. CASE PRESENTATION: We present two patients with incidental electrocardiography (ECG) showing the typical Wellens'-related changes, with an underlying severe triple-vessel coronary artery disease a few weeks following a severe COVID-19 infection associated with high inflammatory markers. The stenotic lesions were diagnosed by cardiac catheterization, and both patients underwent Coronary Artery Bypass Grafting successfully. Notably, patients' baseline ECGs were normal, and they were maintained on Rivaroxaban 10 mg following their viral illness. CONCLUSION: Despite advances in the preventive measures for COVID-19 complications, its pathophysiologic impact on vasculature and atherosclerosis is still incompletely understood. Further clinical trials must be conducted to study this association between Wellens' syndrome and this virus to prevent life-threatening complications.

An electrophysiological substrate of COVID-19.

SARS-CoV-2 infection is associated with an increased risk of late cardiovascular (CV) outcomes. However, more data is needed to describe the electrophysiologic (EP) manifestation of post-acute CV sequelae of COVID-19. We compared two cohorts of adult patients with SARS-CoV-2 polymerase chain reaction (PCR) test and an electrocardiogram (ECG) performed between March 1, 2020, and September 13, 2020, in a retrospective double-cohort study, "Cardiovascular Risk Stratification in Covid-19" (CaVaR-Co19; NCT04555187). Patients with positive PCR comprised a COVID-19(+) cohort (n = 41; 61% women; 80% symptomatic), whereas patients with negative tests formed the COVID-19(-) cohort (n = 155; 56% women). In longitudinal analysis, comparing 3 ECGs recorded before, during, and on average 40 days after index COVID-19 episode, after adjustment for demographic and socioeconomic characteristics, baseline CV risk factors and comorbidities, use of prescription medications (including QT-prolonging drugs) before and during index COVID-19 episode, and the longitudinal changes in RR' intervals, heart rhythm, and ventricular conduction type, only in the COVID-19(+) cohort QTc increased by +30.2(95% confidence interval [CI] 0.1-60.3) ms and the spatial ventricular gradient (SVG) elevation increased by +13.5(95%CI 1.2-25.9)°. In contrast, much smaller, statistically nonsignificant changes were observed in the COVID-19(-) cohort. In conclusion, post-acute CV sequelae of SARS-CoV-2 infection manifested on ECG by QTc prolongation and rotation of the SVG vector upward.

Prevalence and diagnostic significance of de-novo 12-lead ECG changes after COVID-19 infection in elite soccer players.

BACKGROUND AND AIM: The efficacy of pre-COVID-19 and post-COVID-19 infection 12-lead ECGs for identifying athletes with myopericarditis has never been reported. We aimed to assess the prevalence and significance of de-novo ECG changes following COVID-19 infection. METHODS: In this multicentre observational study, between March 2020 and May 2022, we evaluated consecutive athletes with COVID-19 infection. Athletes exhibiting de-novo ECG changes underwent cardiovascular magnetic resonance (CMR) scans. One club mandated CMR scans for all players (n=30) following COVID-19 infection, despite the absence of cardiac symptoms or de-novo ECG changes. RESULTS: 511 soccer players (median age 21 years, IQR 18-26 years) were included. 17 (3%) athletes demonstrated de-novo ECG changes, which included reduction in T-wave amplitude in the inferior and lateral leads (n=5), inferior leads (n=4) and lateral leads (n=4); inferior T-wave inversion (n=7); and ST-segment depression (n=2). 15 (88%) athletes with de-novo ECG changes revealed evidence of inflammatory cardiac sequelae. All 30 athletes who underwent a mandatory CMR scan had normal findings. Athletes revealing de-novo ECG changes had a higher prevalence of cardiac symptoms (71% vs 12%, p<0.0001) and longer median symptom duration (5 days, IQR 3-10) compared with athletes without de-novo ECG changes (2 days, IQR 1-3, p<0.001). Among athletes without cardiac symptoms, the additional yield of de-novo ECG changes to detect cardiac inflammation was 20%. CONCLUSIONS: 3% of athletes demonstrated de-novo ECG changes post COVID-19 infection, of which 88% were diagnosed with cardiac inflammation. Most affected athletes exhibited cardiac symptoms; however, de-novo ECG changes contributed to a diagnosis of cardiac inflammation in 20% of athletes without cardiac symptoms.

Electrocardiogram QRS Complex Duration as a Predictor of Hospital Prognosis in Patients With COVID-19.

Aim      To determine the effect of major electrocardiographic (ECG) parameters on the prognosis of patients with COVID-19.Material and methods  One of systemic manifestations of COVID-19 is heart injury. ECG is the most simple and available method for diagnosing the heart injury, which influences the therapeutic approach. This study included 174 hospitalized patients with COVID-19. Major ECG parameters recorded on admission and their changes before the discharge from the hospital or death of the patient, were analyzed, and the effect of each parameter on the in-hospital prognosis was determined. Results were compared with the left ventricular ejection fraction (LV EF), laboratory data, and results of multispiral computed tomography (MSCT) of the lungs.Results ECG data differed on admission and their changes differed for deceased and discharged patients. Of special interest was the effect of the QRS complex duration at baseline and at the end of treatment on the in-hospital survival and mortality rate. The Cox regression analysis showed that the QRS complex duration (relative risk (RR) 2.07, 95% confidence interval (CI): 1.17-3.66; р=0.01), MSCT data (RR, 1.54; 95 % CI: 1.14-2.092; р=0.005), and glomerular filtration rate (GFR) (RR, 0.98; 95 % CI: 0.96-0.99; р=0.001) had the highest predictive significance. In further comparison of these three indexes, the QRS duration and GFR retained their predictive significance, and a ROC analysis showed that the cut-off QRS complex duration was 125 ms (р=0.001). Patients who developed left bundle branch block (LBBB) in the course of disease also had an unfavorable prognosis compared to other intraventricular conduction disorders (р=0.038). The presence of LBBB was associated with reduced LV EF (р=0.0078). The presence of atrial fibrillation (AF) significantly predetermines a worse outcome both at the start (р=0.011) and at the end of observation (р=0.034). A higher mortality was observed for the group of deceased patients with ST segment deviations, ST elevation (р=0.0059) and ST depression (р=0.028).Conclusion      Thus, the QTc interval elongation, LBBB that developed during the treatment, AF, and increased QRS complex duration are the indicators that determine the in-hospital prognosis of patients with COVID-19. The strongest electrocardiographic predictor for an unfavorable prognosis was the QRS complex duration that allowed stratification of patients to groups of risk.

Prognostic Value of T-wave Positivity in Lead aVR in COVID-19 Pneumonia.

OBJECTIVE: T-wave positivity in the lead aVR is a marker of ventricular repolarization abnormality and provides information on short- and long-term cardiovascular mortality in heart failure patients, those with anterior myocardial infarction, and patients who underwent hemodialysis for various reasons. The aim of this study was to investigate the relationship between T-wave positivity in the lead aVR on superficial electrocardiogram and mortality from COVID-19 pneumonia. METHODS: This study retrospectively included 130 patients who were diagnosed with COVID-19 and treated as an outpatient or in the thoracic diseases ward in a single center between January 2021 and June 2021. All patients included in the study had clinical and radiological features and signs of COVID-19 pneumonia. The COVID-19 diagnosis of all patients was confirmed by polymerase chain reaction detected from an oropharyngeal swab. RESULTS: A total of 130 patients were included in this study. Patients were divided into two groups: survived and deceased. There were 55 patients (mean age: 64.76-14.93 years, 58.18 male, 41.12% female) in the survived group and 75 patients (mean age: 65-15 years, 58.67 male, 41.33% female) in the deceased group. The univariate and multivariate regression analyses showed that positive transcatheter aortic valve replacement (OR 5.151; 95%CI 1.001-26.504; p=0.0012), lactate dehydrogenase (OR 1.006; 95%CI 1.001-1.010; p=0.012), and d-dimer (OR 1.436; 95%CI 1.115-1.848; p=0.005) were independent risk factors for mortality. CONCLUSION: A positive transcatheter aortic valve replacement is useful in risk stratification for mortality from COVID-19 pneumonia.

Takotsubo syndrome in COVID-19: a case series study.

BACKGROUND: Takotsubo syndrome is a clinical syndrome characterized by an acute and transient left ventricular systolic dysfunction related to an emotional or physical stressful event. CASE PRESENTATION: During the Covid-19 pandemic, five cases of Takotsubo syndrome in hospitalized, mechanically ventilated patients due critical SARS-CoV-2 infection have been identified at our institution. Here we present the electrocardiographic, echocardiographic and angiographic characteristics of this case series. All cases were initially suspected by echocardiography performed due an abnormal electrocardiogram, troponin elevation or clinical deterioration. CONCLUSION: A high index of suspicion should be sought to identify Takotsubo syndrome and other cardiac complications associated with SARS-CoV-2 infection.

Clinical and Cardiovascular Characteristics of Patients Suffering ST-Segment Elevation Myocardial Infarction After Covid-19: A Systematic Review and Meta-Analysis.

ST-segment elevation myocardial infarction (STEMI) is one of the fatal complications following Covid-19. We aimed to systematically assess the clinical sequels as well as cardiovascular findings in patients suffering STEMI following Covid-19.The manuscripts databases including PubMed, Web of knowledge (ISI), SCOPUS, Embase, and Google Scholar were deeply searched by the two reviewers using the relevant keywords related to the issue considered in the current review. Of 88 studies initially reviewed, 9 articles were included in final assessment. Nine articles including 447 patients with Covid-19 were included in the study. In terms of electrocardiographic findings, anterior lead involvement was reported in 12% - 61.6% of cases, inferior lead in 28.2% - 75% and lateral involvement in 7.7% - 100% of cases. The prevalence of LBBB was in the range of 10.7% - 61.6% of cases. In terms of echocardiographic findings, a decrease in left ventricular ejection fraction was reported in 60% - 88% of patients. Wall motion abnormality was also observed in 60% - 82.1% of patients. In terms of angiographic findings, the multi-vessel disease was reported in 17.9% - 69% of cases. Also, 24% - 83% of cases needed to revascularization procedures. Cardiac arrest was also reported in 3.1% - 28.2% of cases. Based on the meta-analysis performed on the mortality of patients with STEMI in the field of Covid-19, the pooled prevalence of mortality was estimated at 25.2% (95%CI:17.5%-34.8%). Mortality and adverse consequences of STEMI in patients with Covid-19 are far higher than in the general population. Therefore, in-hospital cardiovascular tracking and monitoring of Covid-19 patients with potential cardiovascular disorders is necessary to achieve a more favorable outcome.

Syncope after COVID-19 Vaccination in a Young Man with Unmasking Brugada Syndrome.

A 23-year-old man with no significant medical history was rushed to a hospital due to transient loss of consciousness with incontinence. The patient had developed a fever after his second dose of coronavirus disease 2019 (COVID-19) vaccine, and the patient was found groaning in bed approximately 40 hours after the vaccination in the early morning. The patient was diagnosed with Brugada syndrome (BrS) based on a drug-provocation test. His father had been diagnosed with BrS and died suddenly at 51 years of age. Young adults with a family history of BrS should be cautioned about fever following COVID-19 vaccination.