Abstract
Inappropriate sinus tachycardia (IST) is a common observation in patients with post-COVID-19 syndrome (PCS) but has not yet been fully described to date. To investigate the prevalence and the mechanisms underlying IST in a prospective population of PCS patients. Consecutive patients admitted to the PCS Unit between June and December 2020 with a resting sinus rhythm rate ≥ 100 bpm were prospectively enrolled in this study and further examined by an orthostatic test, 2D echocardiography, 24-h ECG monitoring (heart rate variability was a surrogate for cardiac autonomic activity), quality-of-life and exercise capacity testing, and blood sampling. To assess cardiac autonomic function, a 2:1:1 comparative sub-analysis was conducted against both fully recovered patients with previous SARS-CoV-2 infection and individuals without prior SARS-CoV-2 infection. Among 200 PCS patients, 40 (20%) fulfilled the diagnostic criteria for IST (average age of 40.1 ± 10 years, 85% women, 83% mild COVID-19). No underlying structural heart disease, pro-inflammatory state, myocyte injury, or hypoxia were identified. IST was accompanied by a decrease in most heart rate variability parameters, especially those related to cardiovagal tone: pNN50 (cases 3.2 ± 3 vs. recovered 10.5 ± 8 vs. non-infected 17.3 ± 10; p < 0.001) and HF band (246 ± 179 vs. 463 ± 295 vs. 1048 ± 570, respectively; p < 0.001). IST is prevalent condition among PCS patients. Cardiac autonomic nervous system imbalance with decreased parasympathetic activity may explain this phenomenon.
Highlights
Inappropriate sinus tachycardia (IST) is a common observation in patients with post-COVID-19 syndrome (PCS) but has not yet been fully described to date
We found that IST is prevalent among PCS patients, and this disorder was more common in young women without previous comorbidities and with mild SARS-CoV-2 infection
This is supported by the 24-h ECG monitoring, as IST was accompanied by a decrease in most heart rate variability (HRV) parameters, predominantly during the daytime, and the most reduced components were those related to the cardiovagal tone
Summary
Inappropriate sinus tachycardia (IST) is a common observation in patients with post-COVID-19 syndrome (PCS) but has not yet been fully described to date. To investigate the prevalence and the mechanisms underlying IST in a prospective population of PCS patients. More than 100 million people have been infected with SARS-CoV-2 worldwide Most of these patients experience mild symptoms that do not warrant hospital admission. Approximately 20–40% of patients remain symptomatic weeks, or even months, after overcoming the acute infection p hase[1] This phenomenon is regarded as ongoing symptomatic COVID-19 or post-COVID-19 syndrome (PCS) when remnant symptoms persist from 4 to 12 weeks and for more than 12 weeks, respectively[2]. The aim of this study was to investigate the prevalence and underlying pathophysiological mechanisms of IST in a consecutive and prospective population of PCS patients
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