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.

Reduced exercise capacity, chronotropic incompetence, and early systemic inflammation in cardiopulmonary phenotype Long COVID

“…23 Another study estimated that Durstenfeld et al CPET, CMR, and Ambulatory Rhythm Findings >12 months after COVID-19 the prevalence of inappropriate sinus tachycardia is 20% among individuals with PASC; we only identified one individual (without cardiopulmonary symptoms) with resting sinus heart rate >=100 bpm and average sinus rate >90 bpm on ambulatory monitoring. 73 Nonetheless, our findings regarding heart rate variability among those with chronotropic incompetence are consistent with theirs regarding heart rate variability. Our findings suggest that arrhythmias or inappropriate sinus tachycardia are unlikely to explain symptoms among those with PASC more than 1 year after infection.…”

Postural orthostatic tachycardia syndrome as a sequela of COVID-19

“… 31 , 77 In addition, many post-COVID-19 patients may exhibit inappropriate sinus tachycardia (IST) and may not have a postural increase in their HR. 31 , 78 , 79 For patients with post-COVID-19 IST, the treatment approach would be very similar to POTS. 31 For the majority of post-COVID-19 patients, minimal testing is required to evaluate for POTS.…”

Neuromuskuläre Manifestationen beim Long-COVID-Syndrom

“…Diese kann auftreten, ohne dass eine strukturelle Herzerkrankung oder andere Ursache vorliegen. Einer Studie zufolge geht diese Sinustachykardie mit einer reduzierten Herzfrequenzvariabilität einher, sodass die Autoren postulieren, dass eine verminderte Aktivität des Parasympathikus hierfür ursächlich ist [ 1 ].…”