Electrocardiographic Features at Admission and During Hospitalization in Patients with COVID-19

Abstract

Background: Besides respiratory complications of SARS-CoV-2, evidence suggests cardiac involvement and its potential role in prognosis. This study aimed to investigate ECG features and the occurrence of arrhythmias associated with disease severity in COVID-19 patients. Methods: A total of 256 patients diagnosed with SARS-CoV-2 infection were included. Baseline characteristics, clinical examinations, and laboratory tests were evaluated. Electrocardiographic parameters, including PR interval, QRS duration, corrected QT interval (QTc), frequency of bundle branch blocks, and ST-T segment changes, were assessed at admission and during hospitalization. Comparisons were made between critically ill patients and those with less severe disease, as well as between patients with and without ischemic heart disease (IHD) or elevated troponin levels. The incidence of arrhythmic events was also analyzed. Findings: Critically ill patients were older. Although baseline ECG parameters did not significantly differ by disease severity, PR and QT intervals were significantly prolonged in critically ill patients during hospitalization. Prolonged QTc was also observed in patients with a history of IHD and elevated troponin levels. The most common arrhythmia was atrial fibrillation, with a prevalence of 2.34. Other abnormal rhythms included junctional rhythm (0.39), complete heart block (0.39), and sustained monomorphic ventricular tachycardia (0.39). Conclusion: Patients with severe SARS-CoV-2 infection exhibited a higher occurrence of ECG abnormalities, including prolonged PR and QT intervals and an increased occurrence of atrial fibrillation during hospitalization. Furthermore, baseline ECG abnormalities were more frequent in critically ill patients, which may highlight the potential role of ECG findings in early risk assessment and prognosis. © 2025, Isfahan University of Medical Sciences(IUMS). All rights reserved.