Introduction: Coronavirus disease 2019 (COVID-19) has been associated with cardiac arrhythmias. Several electrocardiographic markers have been used to predict the risk of arrhythmia in patients with COVID-19. We aim to investigate the electrocardiographic (ECG) ventricular repolarization indices in patients with COVID-19. Methodology: We performed a comprehensive systematic literature search from PubMed, EuropePMC, SCOPUS, Cochrane Central Database, and Google Scholar Preprint Servers. The primary endpoints of this search were: Tp-e (T-peak-to-T-end) interval, QTd (QT dispersion), and Tp-e/QTc ratio in patients with newly diagnosed COVID-19 from inception up until August 2020. Results: There were a total of 241 patients from 2 studies. Meta-analysis showed that Tp-e/QTc ratio was higher in COVID-19 group (mean difference 0.02 [0.01, 0.02], p < 0.001; I2: 18%,). Tp-e interval was more prolonged in COVID-19 group (mean difference 7.76 [3.11, 12.41], p < 0.001; I2: 80%) compared to control group. QT dispersion (QTd) also was increased in COVID-19 group (mean difference 1.22 [0.61, 1.83], p < 0.001 ; I2:30%). Conclusions: Several electrocardiographic markers including Tp-e/QTc, Tp-e interval, and QTd are significantly increased in patients with COVID-19.

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Background:Garlic has been linked to improved cardiovascular health. Garlic has been suggested to lower blood pressure, plasma lipids as well as an antiplatelet effect and other cardiovascular markers.Objective:We aim to assess the latest evidence on the effect of garlic on blood pressure and cholesterol in patients with and without hypertension through systematic review and meta-analysis.Method:We performed a comprehensive search on topics that assesses garlic outcomes in patients with and without hypertension from inception up until December 2020.Results:There were a total of 503 patients from 12 controlled trial studies. Pooled systolic blood pressure was lower in garlic group (mean difference -3.62 [-5.43, -1.80], p = <0.000001; I2: 85%, p < 0.0001). Meta-analysis showed that diastolic blood pressure was lower in garlic group (mean difference -1.40 [-2.72, -0.08], p = <0.00001; I2: 86%, p = 0.04) on follow-up. Total cholesterol was also lower in garlic group (mean difference -17.17 [-28.57, -5.78], p < 0.00001; I2: 86%, p = 0.003). Level of heart rate was similar in garlic and placebo group.Conclusion:This meta-analysis suggests that garlic is associated with reducing blood pressure and cholesterol in patients with and without hypertension. Future long-term trials are needed to elucidate the impact of garlic on cardiovascular morbidity and mortality.

Aims We aimed to examine whether there is abnormal value of index of cardiac electrophysiological balance (iCEB=QT/QRS) in patients with confirmed coronavirus disease 2019 (COVID-19), which can predict ventricular arrhythmias (VAs), including non-Torsades de Pointes-like ventricular tachycardia/ventricular fibrillation (non-TdPs-like VT/VF) in low iCEB and Torsades de Pointes (TdPs) in high iCEB. We also investigated low voltage ECG among COVID-19 group. Methods and Results This is a cross-sectional, single center study with a total of 53 newly diagnosed COVID-19 patients (confirmed with polymerase chain reaction (PCR) test) and 63 age and sex-matched control subjects were included in the study. Electrocardiographic marker of iCEB were calculated manually from 12-lead ECG. Low voltage ECG defined as peak-to-peak QRS voltage less than 5 mm in all limb leads and less than 10 mm in all precordial leads. Patients with COVID-19 more often had low iCEB, defined as iCEB below 3.24 compared to control group (56.6% vs 11.1%), (OR = 10.435; 95%CI 4.015 – 27.123; p = 0.000). There were no significant association between COVID-19 and high iCEB, defined as iCEB above 5.24 (OR = 1.041; 95%CI 0.485 – 2.235; p = 0.917). There were no significant difference of the number of low voltage ECG between COVID-19 and control groups (15.1% vs 6.3%), (OR = 2.622; 95%CI 0.743 - 9.257, p = 0.123). Conclusion In this study showed that patients with COVID-19 are more likely to have low iCEB, suggesting that patients with COVID-19 may be proarrhytmic (towards non-TdPs-like VT/VF event), due to the alleged myocardial involvement in SARS-CoV-2 infection.

Background: Cardiac arrhythmias are significantly associated with poor outcomes in coronavirus disease 2019 patients. Microvolt T-wave alternans (TWA) can be automatically quantified and has been recognized as a representation of repolarization heterogeneity and linked to arrhythmogenesis in various cardiovascular diseases. This study aimed to explore the correlation between microvolt TWA and COVID-19 pathology.Methods: Patients suspected of COVID-19 in Mohammad Hoesin General Hospital were consecutively evaluated using Alivecor ® Kardiamobile 6L™ portable electrocardiogram (ECG) device. Severe COVID-19 patients or those who are unable to cooperate in active ECG self-recording were excluded from the study. TWA was detected and its amplitude was quantified using the novel enhanced adaptive match filter (EAMF) method.Results: A total of 175 patients, 114 COVID-19 patients (polymerase chain reaction (PCR)-positive group), and 61 non-COVID-19 pa-tients (PCR-negative group) were enrolled in the study. PCR-positive group was subdivided according to the severity of COVID-19 pathology into mild and moderate severity subgroups. Baseline TWA levels were similar between both groups during admission (42.47 ± 26.52 µV vs. 44.72 ± 38.21 µV), but higher TWA levels were observed during discharge in the PCR-positive compared to the PCR-negative group (53.45 ± 34.42 µV vs. 25.15 ± 17.64 µV, P = 0.03). The correlation between PCR-positive result in COVID-19 and TWA value was significant, after adjustment of other confounding variables (R 2 = 0.081, P = 0.030). There was no significant difference in TWA levels between mild and moderate severity subgroups in patients with COVID-19, both during admission (44.29 ± 27.14 µV vs. 36.75 ± 24.46 µV, P = 0.34) and discharge (49.47 ± 33.62 µV vs. 61.09 ± 35.99 µV, P = 0.33). Conclusions:Higher TWA values can be observed on follow-up ECG obtained during discharge in the PCR-positive COVID-19 patients.