An electrophysiological substrate of COVID-19
Our manuscript has been published in the Journal of Electrocardiology!
We conducted a double-cohort study of patients with the positive versus negative SARS-CoV-2 PCR test. We conducted a longitudinal analysis and compared 3 ECGs: (1) baseline (before COVID-19), (2) at the time of infection, and (3) after infection. Baseline ECGs were recorded, on average, 3.0±0.3 years before the index COVID-19 ECG (recorded within 30 days of the PCR SARS-CoV-2 test). PCR tests and index ECG recordings were performed on the same day in most patients. Subsequent follow-up ECGs were recorded on average 1.3 ± 0.7 months after the index COVID-19 ECG.
To compare changes in ECG metrics before-during-after COVID-19 in two COVID-19 exposure cohorts, we constructed linear random effect panel data models, adjusted for demographic (age, sex, and race-ethnicity categories), socioeconomic characteristics (insurance status), the reason for testing (presence or absence of COVID-19 symptoms), body mass index, medical history of cardiovascular, cerebrovascular, respiratory, kidney, liver, blood, systemic, endocrine disease, diabetes mellitus, substance addiction including smoking, conditions with immunocompromised and thromboembolic risk, use of prescription medications (including QT-prolonging drugs, Renin-Angiotensin-Aldosterone System-blocking drugs, atrioventricular-nodal agents, antiplatelet or anticoagulant, and immunosuppressants), and the longitudinal changes in RR’ intervals, ventricular conduction type (left or right bundle branch block, or intraventricular conduction delay) and the type of median beat (Normal Sinus, Atrial Fibrillation, Ventricular Paced).
The major finding of this retrospective, longitudinal, double-cohort study was the observation of post-acute cardiovascular sequelae of either symptomatic or asymptomatic SARS-CoV-2 infection, manifested by the development of EP substrate on average 40 days after index COVID-19 episode. Notably, after comprehensive adjustment, cardiovascular sequelae of SARS-CoV-2 infection manifested by QTc prolongation and rotation of the Spatial Ventricular Gradient (SVG) vector upward.
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