Work

Screening for postural orthostatic tachycardia syndrome using 24-hour electrocardiogram recording in patients with long coronavirus disease

Year: 2025

Type: article

Abstract: Background Cardiovascular autonomic dysfunction (CVAD) is a major complication in a large proportion of long COVID patients. One of the most typical phenotypes of CVAD, postural orthostatic tachycardia syndrome (POTS) is commonly observed as a sequalae of COVID infection. Objective The purpose of the study was to develop and test 24h-ECG recording to direct the clinical suspicion towards the diagnosis of POTS. Methods Consecutive patients referred to the Karolinska University Hospital in Stockholm, from April 2021 to April 2022 were included. Patients with POTS were compared with long COVID patients without POTS (verified by active standing tests) and control healthy subjects according to 3 specific analyses based on 24-h ECG recording: (1) heart rate (HR) spikes>30 bpm; (2) awakening HR increase; and (3) HR variability (RMSSD). The control group consisted of healthy subjects from database of the University Hospital of Saint-Etienne. Results A total of 100 long COVID patients (mean age: 42.54±10.45y, 92% women) and 100 healthy subjects (41.40±7.21y, 96% women) were included. Long-COVID POTS (n=45) was associated with (1) higher number of HR spikes/h (1.47±0.84 vs. 0.68±0.50 and 0.40±0.28/h, p<0.01), (2) abrupt and sustained increase in HR after awakening (p<0.05), and (3) reduction of HRV: mean RMSSD: 34.90±12.48 vs. 30.47±19.15 and 43.35±21.10 ms (p<0.01) compared with long COVID patients without POTS (n=55) and healthy subjects. Conclusion A triple analysis of 24-h ECG recordings could reveal a characteristic POTS signature in long COVID. More research in other populations is needed to draw any firm conclusions about its generalizability.

Source: Heart Rhythm O2

DOI: 10.1016/j.hroo.2025.04.011