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. 2021 Apr;5(2):368-376.
doi: 10.1016/j.mayocpiqo.2021.01.007. Epub 2021 Feb 8.

Use of Electrocardiographic Screening to Clear Athletes for Return to Sports Following COVID-19 Infection

Jacob L Erickson  1 , Joseph T Poterucha  2   3   4 , Alecia Gende  1 , Mark McEleney  1 , Corey M Wencl  1 , Marisa Castaneda  1 , Lindsay Gran  1 , Joel Luedke  5 , Jill Collum  6 , Karen M Fischer  7 , Andrew R Jagim  1
Affiliations

Use of Electrocardiographic Screening to Clear Athletes for Return to Sports Following COVID-19 Infection

Jacob L Erickson et al. Mayo Clin Proc Innov Qual Outcomes. 2021 Apr.

Abstract

Objective: To quantify the occurrence rate of abnormal electrocardiographic (ECG) findings and symptoms following coronavirus disease 2019 (COVID-19) infection.

Patients and methods: In this retrospective analysis, we studied adult patients (>18 years old) who were participating in collegiate athletics and previously tested positive for COVID-19 between August 1, 2020, and December 30, 2020. The athletes underwent general examinations and ECG screening prior to being medically cleared for a return to sports following their COVID-19 diagnosis. Predetermined predictors were grouped into categorical variables including (1) sex, (2) symptom severity, and (3) body mass index (normal vs overweight [≥24 kg/m2]). These variables were used to examine differences of abnormal rates that occurred between different predictor categories.

Results: Of the 170 athletes screened, 6 (3.5%) presented with abnormal ECG findings and were referred to cardiologists. We found no evidence that sex, symptom severity, and body mass index category were associated with a higher rate of abnormal ECG findings (all P>.05). Greater severity of COVID-19 symptoms was associated with a higher percentage of ST depression, T-wave inversion, ST-T changes, and the presence of fragmented QRS complex. Loss of smell, loss of taste, headache, and fatigue were the most prevalent symptoms, with 38.8% (66), 36.5% (62), 32.9% (56), and 25.3% (43), respectively, of the 170 athletes reporting each symptom.

Conclusion: Preliminary findings indicate a low risk of myocardial injury secondary to COVID-19 infection, with less than 4% of the 170 patients in our study presenting with abnormal ECG findings and a total of 16 patients (9.4%) requiring referral to a cardiologist. Although viral myocarditis was not detected in any athlete referred for cardiological assessment, 2 patients experienced effusive viral pericarditis.

Keywords: BMI, body mass index; COVID-19, coronavirus disease 2019; ECG, electrocardiography; NCAA, National Collegiate Athletic Association.

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