Risk assessment of cardiac arrhythmias in the early post-COVID-19 period in non-hospitalized patients—long-term data from the PoLoCOV-CVD study

Many studies have shown that SARS-CoV-2 infection requiring hospitalization may result in myocardial damage, heart failure or cardiac arrhythmias, which leads to a severe course of the disease, worsens the prognosis, and is an independent risk factor for death. The study aimed to assess whether the COVID-19 severity affects the occurrence and type of cardiac arrhythmias among non-hospitalized patients without previous CVD in the early period after SARS-CoV-2 infection. The study included patients with no history of prior CVD who suffered from COVID-19 and were treated on an outpatient basis. Study subjects were divided into two groups based on the severity of their COVID-19 course. In the post-COVID period (average 12 ± 6 weeks), patients underwent a standard 12-lead resting electrocardiogram (ECG) and a 24-h Holter monitoring. The analysis included 893 patients, among whom 25.2% had a severe course of COVID-19. Age (p = 0.02) and cardiac dysfunction [ejection fraction < 50% and/or contractile dysfunction on echocardiography (p = 0.01)] were associated with a higher risk of cardiac arrhythmias after COVID-19. The most commonly observed ECG abnormalities were prolonged QRS complex duration (p = 0.035) and the occurrence of supraventricular extrasystoles (p = 0.037). Multivariate regression analysis showed that independent risk factors associated with the occurrence of cardiac arrhythmias in non-hospitalized patients after COVID-19 include age, systolic and diastolic LV diameter, LA diameter, and the presence of at least one chronic disease. Based on the analysis of the obtained results, it was observed that the occurrence of cardiac arrhythmias in the early post-COVID-19 period among non-hospitalized patients without prior CVD does not depend on COVID-19 severity. However, identifying significant ventricular arrhythmias should prompt echocardiographic evaluation due to the high risk of left ventricular dysfunction.