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Multicenter Study
. 2020 Dec 23;22(12):1848-1854.
doi: 10.1093/europace/euaa258.

Electrocardiographic features of 431 consecutive, critically ill COVID-19 patients: an insight into the mechanisms of cardiac involvement

Matteo Bertini  1 , Roberto Ferrari  1   2 , Gabriele Guardigli  1 , Michele Malagù  1 , Francesco Vitali  1 , Ottavio Zucchetti  1 , Emanuele D'Aniello  1 , Carlo Alberto Volta  3 , Paolo Cimaglia  2 , Giancarlo Piovaccari  4 , Alessandro Corzani  5 , Marcello Galvani  6 , Paolo Ortolani  7 , Andrea Rubboli  8 , Gianfranco Tortorici  9 , Gianni Casella  10 , Biagio Sassone  11 , Alessandro Navazio  12 , Luca Rossi  13 , Daniela Aschieri  14 , Claudio Rapezzi  1   2
Affiliations
Multicenter Study

Electrocardiographic features of 431 consecutive, critically ill COVID-19 patients: an insight into the mechanisms of cardiac involvement

Matteo Bertini et al. Europace. .

Abstract

Aims: Our aim was to describe the electrocardiographic features of critical COVID-19 patients.

Methods and results: We carried out a multicentric, cross-sectional, retrospective analysis of 431 consecutive COVID-19 patients hospitalized between 10 March and 14 April 2020 who died or were treated with invasive mechanical ventilation. This project is registered on ClinicalTrials.gov (identifier: NCT04367129). Standard ECG was recorded at hospital admission. ECG was abnormal in 93% of the patients. Atrial fibrillation/flutter was detected in 22% of the patients. ECG signs suggesting acute right ventricular pressure overload (RVPO) were detected in 30% of the patients. In particular, 43 (10%) patients had the S1Q3T3 pattern, 38 (9%) had incomplete right bundle branch block (RBBB), and 49 (11%) had complete RBBB. ECG signs of acute RVPO were not statistically different between patients with (n = 104) or without (n=327) invasive mechanical ventilation during ECG recording (36% vs. 28%, P = 0.10). Non-specific repolarization abnormalities and low QRS voltage in peripheral leads were present in 176 (41%) and 23 (5%), respectively. In four patients showing ST-segment elevation, acute myocardial infarction was confirmed with coronary angiography. No ST-T abnormalities suggestive of acute myocarditis were detected. In the subgroup of 110 patients where high-sensitivity troponin I was available, ECG features were not statistically different when stratified for above or below the 5 times upper reference limit value.

Conclusions: The ECG is abnormal in almost all critically ill COVID-19 patients and shows a large spectrum of abnormalities, with signs of acute RVPO in 30% of the patients. Rapid and simple identification of these cases with ECG at hospital admission can facilitate classification of the patients and provide pathophysiological insights.

Keywords: Critically ill COVID-19; ECG; Right ventricular pressure overload.

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Figures

Figure 1
Figure 1
Spectrum of electrocardiogram abnormalities associated with right ventricular pressure overload: presence of S1Q3T3 pattern and sinus rhythm.
Figure 2
Figure 2
Spectrum of electrocardiogram abnormalities associated with right ventricular pressure overload: presence of the S1Q3T3 pattern associated with right bundle branch block and atrial flutter.
Figure 3
Figure 3
No differences in positive end-expiratory pressure (PEEP) values between patients with and without ECG signs of right ventricular pressure overload (RVPO).
See this image and copyright information in PMC

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