Prospective arrhythmia surveillance after a COVID-19 diagnosis

Open Heart. 2022 Jan;9(1):e001758. doi: 10.1136/openhrt-2021-001758.


Background: Cardiac arrhythmias have been observed among patients hospitalised with acute COVID-19 infection, and palpitations remain a common symptom among the much larger outpatient population of COVID-19 survivors in the convalescent stage of the disease.

Objective: To determine arrhythmia prevalence among outpatients after a COVID-19 diagnosis.

Methods: Adults with a positive COVID-19 test and without a history of arrhythmia were prospectively evaluated with 14-day ambulatory electrocardiographic monitoring. Participants were instructed to trigger the monitor for palpitations.

Results: A total of 51 individuals (mean age 42±11 years, 65% women) underwent monitoring at a median 75 (IQR 34-126) days after a positive COVID-19 test. Median monitoring duration was 13.2 (IQR 10.5-13.8) days. No participant demonstrated atrial fibrillation, atrial flutter, sustained supraventricular tachycardia (SVT), sustained ventricular tachycardia or infranodal atrioventricular block. Nearly all participants (96%) had an ectopic burden of <1%; one participant had a 2.8% supraventricular ectopic burden and one had a 15.4% ventricular ectopic burden. While 47 (92%) participants triggered their monitor for palpitation symptoms, 78% of these triggers were for either sinus rhythm or sinus tachycardia.

Conclusions: We did not find evidence of malignant or sustained arrhythmias in outpatients after a positive COVID-19 diagnosis. While palpitations were common, symptoms frequently corresponded to sinus rhythm/sinus tachycardia or non-malignant arrhythmias such as isolated ectopy or non-sustained SVT. While these findings cannot exclude the possibility of serious arrhythmias in select individuals, they do not support a strong or widespread proarrhythmic effect of COVID-19 infection after resolution of acute illness.

Keywords: COVID-19; arrhythmias; electrophysiology.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Arrhythmias, Cardiac / diagnosis
  • Arrhythmias, Cardiac / epidemiology*
  • Arrhythmias, Cardiac / etiology
  • COVID-19 / complications
  • COVID-19 / diagnosis*
  • COVID-19 / virology
  • Electrocardiography, Ambulatory / methods*
  • Female
  • Global Health
  • Humans
  • Incidence
  • Male
  • Pandemics*
  • Population Surveillance*
  • Prospective Studies
  • SARS-CoV-2*