Long-Term Impact of COVID-19 on Heart Rate Variability: A Systematic Review of Observational Studies

Abstract

Coronavirus disease 2019 (COVID-19) sequelae (or long COVID) has become a clinically significant concern. Several studies have reported the relationship between heart rate variability (HRV) parameters and COVID-19. This review investigates the long-term association between COVID-19 and HRV parameters. Four electronic databases were searched up to 29 July 2022. We included observational studies comparing HRV parameters (measurement durations: 1 min or more) in participants with and without a history of COVID-19. We used assessment tools developed by the National Heart, Lung, and Blood Institute group to evaluate the methodological quality of included studies. Eleven cross-sectional studies compared HRV parameters in individuals who recovered from acute COVID-19 infection to controls (n = 2197). Most studies reported standard deviation of normal-to-normal intervals (SDNN) and root mean square of the successive differences. The methodological quality of the included studies was not optimal. The included studies generally found decreased SDNN and parasympathetic activity in post-COVID-19 individuals. Compared to controls, decreases in SDNN were observed in individuals who recovered from COVID-19 or had long COVID. Most of the included studies emphasized parasympathetic inhibition in post-COVID-19 conditions. Due to the methodological limitations of measuring HRV parameters, the findings should be further validated by robust prospective longitudinal studies.

Mechanisms underlying exercise intolerance in long COVID: An accumulation of multisystem dysfunction

“…There was heterogeneity across measures of autonomic function in long COVID cases. On average, HR recovered more rapidly in controls than in long COVID cases, in line with previous work (Asarcikli et al., 2022 ; Contreras et al., 2023 ; Dani et al., 2021 ; Marques et al., 2022 ; Suh et al., 2023 ). During the lying to standing maneuver, one individual met the clinical criteria for orthostatic hypotension and a further two met the criteria for POTS (Raj et al., 2021 ).…”

Physical Activity in Long COVID: A Comparative Study of Exercise Rehabilitation Benefits in Patients with Long COVID, Coronary Artery Disease and Fibromyalgia

“…Their results revealed a reduction in global HRV, increased sympathetic modulation influence and a decrease in parasympathetic modulation in long COVID [69]. A recent systematic review confirmed a decreased parasympathetic activity, although the authors suggested standard deviation of all NN intervals as a reference parameter [70]. This seems comparable to our HRV data, suggesting long COVID patients tend to have a sympathetic profile with a very low parasympathetic component.…”

Changes in dynamic electrocardiogram after COVID-19 infection: a self-controlled study

“…Long COVID-19 refers to the signs and symptoms that continue or appear after the acute COVID-19 stage [25][26][27],most of our study population are belong to this. Research has found that the mechanism of long COVID-19 may be related to autonomic dysfunction [28].In the two meta-analyses published in 2022 on COVID-19 and HRV, a total of 31 articles were included [29,30]. The vast majority of the 31 articles compared HRV parameters between acute phase patients and healthy control groups, with different methods for comparing HRV parameters, including bedside electrocardiogram monitoring, wearable devices, conventional 12 lead electrocardiogram, and a small number of articles also using 24 h Holter ECG.…”