Electrocardiographic findings in COVID-19: analysis of tele-ECGs in Moscow ECG IT Center

BACKGROUND: Coronavirus disease (COVID-19) affects the cardiovascular system and the primary damage to the respiratory system involved in the pathological process. However, in the available literature, the electrocardiography (ECG) analyses are based only on small-sample studies and case reports, which determine the relevance of larger-scale studies to clarify the nature and prevalence of ECG abnormalities in subjects with confirmed coronavirus infection.

AIM: To determine the distribution of ECG changes in COVID-19 patients representing a non-selective population of Moscow residents.

MATERIALS AND METHODS: We performed a retrospective analysis of ECGs from 42,799 patients from March 10, 2020 to March 10, 2021 with a verified diagnosis of COVID-19 was performed. The study included patients admitted to Moscow clinical hospitals connected to the ECG IT Center. A standard 12-lead ECG was obtained and transmitted via an Internet connection to the server of the ECG IT Center, where the ECG interpretation was performed.

RESULTS: ECG changes were detected in 54% of patients. The most common cardiac arrhythmias were supraventricular extrasystole (12.6%) and atrial fibrillation (12.0%) reported in patients. Signs of the overloaded right heart were detected in 12.5% of cases, of which the ECG pattern of pulmonary embolism was confirmed in 485 patients (1.13%). Infarction ECG pattern was observed in 4.5% of patients, among which 3 cases of Brugada ECG pattern were reported. The incidence of ST-T changes was 2.2% of all study patients. Prolonged QT and QTc intervals were recorded in 540 patients (1.26%). In addition, individual cases of ventricular fibrillation, Frederick syndrome, and atrioventricular block of various degrees were reported.

CONCLUSION: The distribution of incidence of ECG changes in COVID-19 was shown based on the data obtained. The high incidence of atrial fibrillation, which is a risk factor for thromboembolic complications, was confirmed. Moreover, a significant prevalence of ECG patterns of overloaded right heart was shown, some are associated with pulmonary embolism. Other reported ECG changes were characterized by a significantly lower prevalence, which does not reduce their clinical significance. The data obtained may be used to improve COVID-19 patient management strategy in the future.