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Update: Cardiac Complications Post-COVID and the need for ECG Monitoring

SARS-CoV-2 most notably causes respiratory symptoms, but the virus can infect almost any organ in the body.1 With almost four years of data on the COVID-19 pandemic, physicians and researchers alike are closely monitoring how the disease progresses from short-term infections to long-term complications.

Recent studies have indicated the emergence of “Long COVID,” a condition characterized by COVID-19 symptoms persisting beyond 3 months.2 As of September 2022, an estimated 24 million — 1 in 5 — U.S. adults developed long COVID after initial infection with SARS-CoV-2.3

Among the most alarming long COVID symptoms are cardiovascular abnormalities, which are becoming increasingly common in low-risk individuals, including healthy children and young adults.4

Long COVID Cardiac Complications

The most frequently reported cardiovascular issues post-COVID are myocardial infarction, strokes, myocardial inflammation, blood clots, and arrhythmias.5 A large-scale study evaluating cardiovascular outcomes 30 days post-infection calculated a 72% higher risk of heart failure, 63% higher risk of myocardial infarction, and elevated rates of arrhythmias and myocardial inflammation.6 Research also indicates a higher risk of sudden death from arrhythmias and blood clots in the year following infection.7

The widespread persistence of arrhythmias, especially tachycardia and atrial fibrillation (AFib), after SARS-CoV-2 infection is emerging as a significant global health concern.8 The American Heart Association’s COVID-19 Cardiovascular Disease Registry found that 1 in 20 patients hospitalized with COVID were diagnosed with new-onset AFib, considerably increasing their risk of ICU care and in-hospital mortality (45%).9

With a 4-fold higher risk of death from Afib across all age groups, electrocardiograms (ECGs) are being recognized for their critical role in monitoring new and worsening arrhythmias.10

The Role of ECG in Monitoring Post-COVID Arrhythmias

Due to the nature of long COVID, clinicians should be acutely aware of the risk of post-COVID cardiac complications — even in healthy individuals.

Cardiac screening via ECG in long COVID patients is advised in order to detect more severe cardiac complications, notably AFib and left ventricular dysfunction.11 In fact, arrhythmias and other electrocardiographic abnormalities were found in upwards of 1 in 3 patients following mild COVID infections.7

Cardiac Insight designed an ECG system that accelerates the arrhythmia diagnostic process from weeks to days. The Cardea SOLO ECG system is a prescription-based, single-use, 7-day ECG recording sensor equipped with in-office arrhythmia analysis software that reviews every heartbeat. Cardea SOLO ECG Analysis Software automatically detects and reports draft findings for Afib, ventricular tachycardia, and thirteen other abnormal cardiac rhythms and conditions, with 94% sensitivity and 99% PPV for atrial fibrillation and flutter detection.

With Cardea SOLO, physicians can rapidly diagnose, treat, and manage arrhythmias in patients who are at an elevated risk of cardiac complications following infection with SARS-CoV-2.

Learn more about Cardea SOLO and how it can streamline post-COVID arrhythmia diagnosis.

1. Jain, U. (2020). Effect of COVID-19 on the Organs. Cureus 12(8), e9540.
2. Raman, B., Bleumke, D.A., Lüscher, T.F., Neubauer, S. (2022). Long COVID: post-acute sequelae of COVID-19 with a cardiovascular focus. European Heart Journal 43(11), 1157-1172.
3. Bull-Otterson, L., Baca, S., Saydah, S., Boehmer, T.K., Adjei, S., Gray, S., Harris, A.M. (2022). Post-COVID Conditions Among Adult COVID-19 Survivors Aged 18–64 and ≥65 Years — United States, March 2020–November 2021. MMWR Morbidity and Mortality Weekly Report 71(21), 713-717.
4. Srinivasan, A., Wong, F., Couch, L.S., Wang, B.X. (2022). Cardiac Complications of COVID-19 in Low-Risk Patients. Viruses 14(6), 1322.
5. Abbasi, J. (2022). The COVID Heart–One Year After SARS-CoV-2 Infection, Patients Have an Array of Increased Cardiovascular Risks. JAMA 327(12), 1113-1114.
6. Xie, Y., Xu, E., Bowe, B., Al-Aly, Z. (2022). Long-term cardiovascular outcomes of COVID-19. Nature Medicine 28(3), 583-590.
7. Tobler, D.L., Pruzansky, A.J., Naderi, S., Ambrosy, A.P., Slade, J.J. (2022). Long-Term Cardiovascular Effects of COVID-19: Emerging Data Relevant to the Cardiovascular Clinician. Current Atherosclerosis Reports 24(7), 563-570.
8. Satterfield, B.A., Bhatt, D.L., Gersh, B.J. (2022). Cardiac involvement in the long-term implications of COVID-19. Nature Reviews Cardiology 19(5), 332-341.
9. Rosenblatt, A.G., Ayers, C.R., Rao, A., Howell, S.J., Hendren, N.S., Zadikany, R.H., Ebinger, J.E., Daniels, J.D., Link, M.S., de Lemos, J.A., Das, S.R. (2022). New-Onset Atrial Fibrillation in Patients Hospitalized With COVID-19: Results From the American Heart Association COVID-19 Cardiovascular Registry. Circulation: Arrhythmia and Electrophysiology 15(5), e010666.
10. Romiti, G.F., Corica, B., Lip, G.Y.H., Proietti, M. (2021). Prevalence and Impact of Atrial Fibrillation in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine 10(11), 2490.
11. Zhou, M., Wong, C.K., Un, K..C., Lau, Y.M., Lee, J.C.Y., et al. (2021). Cardiovascular sequelae in uncomplicated COVID-19 survivors. PLoS One 16(2), e0246732.

Commentary by Robert Hauser, MD Chair, Cardiac Insight Scientific Advisory Board