Cor Vasa 2025, 67(5):591-596 | DOI: 10.33678/cor.2025.019

Cardiac sequelae after COVID-19: results of a one-year follow-up study with ECG monitoring

Gabriela Matejová^{a, b}, Martin Radvan^{a, b}, Elis Bartečků^{b, c}, Veronika Bulková^{a, b}, Martin Kameník^{a, b}, Lumír Koc^{a, b}, Jana Hořínková^{b, c}, Radka Štěpánová^d, Petr Kala^{a, b}

^a Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, the Czech Republic

^b Masaryk University, Brno, the Czech Republic

^c Department of Psychiatry, University Hospital Brno, Brno, the Czech Republic

^d Department of Pharmacology, Masaryk University, Brno, the Czech Republic

Objective: To evaluate the need for ECG monitoring of unselected patients recovered from COVID-19 and to estimate the risk of development of arrhythmias and heart rate variability change after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Methods: Between March 2020 and January 2021 patients who had recovered from PCR-proven SARS-CoV-2 symptomatic infection (alfa and beta variants) were enrolled in a prospective observational cohort study CoSuBr (COvid SUrvivals in BRno) and those with two 7-day ECG monitoring have been analysed. Demographic parameters, patient history, clinical evaluation, and 7-day ECG monitoring were recorded within two times intervals: the first at least six weeks after infection and a follow-up visit one year later to establish any changes in heart rate variability (HRV).

Results: The study group consisted of 74 individuals, 42 of which were females (56.8%), with 7-day ECG monitoring performed in both time intervals. The mean age was 48 years (range 21-77 years). The mean time interval between the onset of the infection and the follow-up visit was 105 days. At the time of enrolment, 61% of the patients were experiencing ongoing symptoms, while more than half of the whole group (51.3%) mentioned at least one symptom of possible cardiac origin (breathing problems, palpitations, exercise intolerance, fatigue). There was no change in the average heart rate between visits (72.7 ± 8 vs. 72.5 ± 8/min; p = 0.756), and no difference in the incidence of supraventricular or ventricular ectopy. There was no difference in parameters between symptomatic/asymptomatic groups. At the one-year follow-up visit after COVID-19 infection, there was no change in heart rate variability evaluated by SDNN (V1 vs. V2 156.6 ± 40.6 vs. 156.0 ± 38.0; p = 0.855), rMSSD (V1: 33 ± 13.95 to 30.6 ± 12.89; p = 0.175) and triangle (V1: 28.5 ± 7.8 to 29.5 ± 8.8; p = 0.488). We evaluated the presence of supraventricular and ventricular arrhythmias, and the ECG monitoring showed no significant pathology.

Conclusion: Despite a lot of information regarding cardiac impairment caused by SARS-CoV-2, our study does not suggest an increased risk in developing arrhythmias after COVID-19 in the one-year follow-up. Based on our results, routine ECG monitoring is currently not recommended after recovery from COVID-19.

Keywords: COVID-19, ECG monitoring, Follow-up, Heart rate variability, SARS-CoV-2

Received: January 8, 2025; Revised: January 8, 2025; Accepted: February 2, 2025; Prepublished online: June 2, 2012; Published: November 6, 2025  Show citation