Inappropriate sinus tachycardia in post-COVID-19 syndrome

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.

Figure 1

24-h ECG monitoring and HRV parameters. HRV parameters in the three studied groups: IST, fully recovered and uninfected subjects. HR indicates heart rate; PNN50, percentage of adjacent NN intervals that differ from each other by more than 50 ms; SD, standard deviation of the interbeat interval; VLF, very low frequency; LF, low frequency; HF, high frequency. A P value of < 0.05 is considered statistically significant. *Significant differences compared with fully recovered patients. **Significant differences compared with uninfected patients.

Figure 2

(A) Uninfected subject. Poincaré plot of 24-hour ECG monitoring showing the beat-to-beat variability from an uninfected subject and histogram of the frequencydomain parameters. (B) IST patient. Poincaré plot of 24-h ECG monitoring and histogram of the frequency-domain parameters from a patient with IST. A lower heart rate variability in comparison with the uninfected subject and an overall decrease is observed throughout all bands, being more manifest at the high frequency band (HF, 0.15–0.40 Hz), are both apparent.

Figure 3

Illustration of the pathophysiological mechanisms underlying Post-COVID-19 syndrome.