Changes of ECG parameters after BNT162b2 vaccine in the senior high school students

Abstract

The purpose of this study is to determine the ECG parameter change and the efficacy of ECG screening for cardiac adverse effect after the second dose of BNT162b2 vaccine in young population. In December 2021, in cooperation with the school vaccination system of Taipei City government, we performed a ECG screening study during the second dose of BNT162b2 vaccines. Serial comparisons of ECGs and questionnaire survey were performed before and after vaccine in four male-predominant senior high schools. Among 7934 eligible students, 4928 (62.1%) were included in the study. The male/female ratio was 4576/352. In total, 763 students (17.1%) had at least one cardiac symptom after the second vaccine dose, mostly chest pain and palpitations. The depolarization and repolarization parameters (QRS duration and QT interval) decreased significantly after the vaccine with increasing heart rate. Abnormal ECGs were obtained in 51 (1.0%) of the students, of which 1 was diagnosed with mild myocarditis and another 4 were judged to have significant arrhythmia. None of the patients needed to be admitted to hospital and all of these symptoms improved spontaneously. Using these five students as a positive outcome, the sensitivity and specificity of this screening method were 100% and 99.1%, respectively. Conclusion : Cardiac symptoms are common after the second dose of BNT162b2 vaccine, but the incidences of significant arrhythmias and myocarditis are only 0.1%. The serial ECG screening method has high sensitivity and specificity for significant cardiac adverse effect but cost effect needs further discussed. What is Known: • The incidence of cardiac adverse effects was reported to be as high as 1.5 per 10 000 persons after the second dose BNT162b2 COVID-19 vaccine in the young male population based on the reporting system. What is New: • Through this mass ECG screening study after the second dose of BNT162b2 vaccine we found: (1) The depolarization and repolarization parameters (QRS duration and QT interval) decreased significantly after the vaccine with increasing heart rate; (2) the incidence of post-vaccine myocarditis and significant arrhythmia are 0.02% and 0.08%; (3) The serial ECG screening method has high sensitivity and specificity for significant cardiac adverse effect. Supplementary Information The online version contains supplementary material available at 10.1007/s00431-022-04786-0.

Athlete deaths during the COVID-19 vaccination campaign: contextualisation of online information

“…In Taiwan, researchers conducted an interesting study, in which they compared ECGs before and after the second BNT162b2 dose in 4928 senior high school students (12-18 years). 29 They found significant post-vaccination ECG changes in 51 (1%) students, mostly asymptomatic. Alterations included ST-T changes, premature ventricular contractions (PVC), sinus bradycardia, atrial tachycardia, incomplete right bundle branch block, QRS axis change, and mild QT prolongation.…”

“…The authors concluded that the incidence of clinical and even subclinical myocarditis was low in BNT162b2 vaccine recipients, and that the BNT162b2 vaccine is unlikely to cause life-threatening arrhythmia in healthy young individuals. 29 Hopefully, lay people and medical professionals will rely on verified and properly analysed data to arrive at substantiated conclusions regarding vaccination effects in the years to come. Himelfarb and colleagues have, among others, delineated the consequences of COVID-19 misinformation.…”

Safety of COVID-19 Vaccines in Patients with Autoimmune Diseases, in Patients with Cardiac Issues, and in the Healthy Population

“…The overall incidence of arrhythmia and myocarditis was 0.1%, which means that the most severe manifestations have a frequency of 1 in 1000. The authors mention that the cost of assessing the mRNA-induced adverse events at the cardiac level should stimulate discussion [ 86 ].…”

Cardiac Arrhythmias in Post-COVID Syndrome: Prevalence, Pathology, Diagnosis, and Treatment

“…A large study enrolling 7934 high school students after mRNA vaccination and ECG screening revealed that the second dose of anti-SARS-CoV-2 vaccination with a mRNA-based vaccine can have significant cardiac adverse effects. Thus, among 4928 eligible study participants, 763 students (17.1%) had at least one cardiac symptom (mostly chest pain and palpitation); abnormal ECG changes were obtained in 51 subjects (1.0%), of whom one was diagnosed with mild myocarditis whereas four were judged to have significant arrhythmia [ 89 ]. Similarly, very low rates of post-vaccination arrhythmias (about 0.2–1.0%) were observed in a UK study of over 38 million people who received a COVID-19 vaccine, but relatively higher rates were seen in those who had been tested SARS-CoV-2 positive [ 90 ].…”