Is T-Wave Alternans a Repolarization Abnormality Marker in COVID-19? An Investigation on the Potentialities of Portable Electrocardiogram Device

Background

Cardiac arrhythmias are significantly associated with poor outcomes in coronavirus disease 2019 (COVID-19) patients. Microvolt T-wave alternans (TWA) can be automatically quantified and has been recognized as a representation of repolarization heterogeneity and linked to arrhythmogenesis in various cardiovascular diseases. This study aimed to explore the correlation between microvolt TWA and COVID-19 pathology.

Methods

Patients suspected of COVID-19 in Mohammad Hoesin General Hospital were consecutively evaluated using Alivecor^® Kardiamobile 6L™ portable electrocardiogram (ECG) device. Severe COVID-19 patients or those who are unable to cooperate in active ECG self-recording were excluded from the study. TWA was detected and its amplitude was quantified using the novel enhanced adaptive match filter (EAMF) method.

Results

A total of 175 patients, 114 COVID-19 patients (polymerase chain reaction (PCR)-positive group), and 61 non-COVID-19 patients (PCR-negative group) were enrolled in the study. PCR-positive group was subdivided according to the severity of COVID-19 pathology into mild and moderate severity subgroups. Baseline TWA levels were similar between both groups during admission (42.47 ± 26.52 µV vs. 44.72 ± 38.21 µV), but higher TWA levels were observed during discharge in the PCR-positive compared to the PCR-negative group (53.45 ± 34.42 µV vs. 25.15 ± 17.64 µV, P = 0.03). The correlation between PCR-positive result in COVID-19 and TWA value was significant, after adjustment of other confounding variables (R² = 0.081, P = 0.030). There was no significant difference in TWA levels between mild and moderate severity subgroups in patients with COVID-19, both during admission (44.29 ± 27.14 µV vs. 36.75 ± 24.46 µV, P = 0.34) and discharge (49.47 ± 33.62 µV vs. 61.09 ± 35.99 µV, P = 0.33).

Conclusions

Higher TWA values can be observed on follow-up ECG obtained during discharge in the PCR-positive COVID-19 patients.

COVID arm as a common cutaneous manifestation after mRNA-1273 vaccination: a systematic review

BACKGROUND

By August 2022, CoronaVirus Disease-2019 (COVID-19) had caused 600 million illnesses and 6.5 million fatalities globally. A massive vaccination program is being implemented worldwide to suppress this condition. Several works of literature stated that mRNA COVID-19 vaccination, specifically with the mRNA-1273 vaccine, is followed by clear evidence of the COVID arm effects associated with this vaccine.

OBJECTIVE

To analyze the latest evidence of COVID arm as a common effect of mRNA-1273 vaccination with the ultimate goal of improving vaccine counseling to help healthcare professionals and reassure patients.

METHODS

A comprehensive search was performed on topics that assess the COVID arm as a cutaneous manifestation following mRNA-1273 vaccination from inception up until July 2022.

RESULTS

Eighteen studies with a total of 1129 participants after the first and second dose of mRNA-1273 vaccination reported that most participants had COVID arm following the first dose administration. The characteristics of the patients were a mean age of 43.8 years old, and females represented ≥ 50% in most studies, with a mean onset of 6.9 days after the first dose administration. Symptoms resolved within seven days following the treatment and were harmless.

CONCLUSIONS

This study found that the COVID arm condition is most common following the first mRNA-1273 vaccination in the female and middle-aged group. The correlation between demographic variables and COVID arm risk elucidates that the reaction is a type IV allergic skin reaction.

OR34. Evaluation of P wave abnormalities in newly diagnosed COVID-19

Aims

The aim of the current study was to evaluate P wave abnormalities, including prolonged P wave duration, prolonged P wave dispersion (PWD) and abnormal P wave axis (PWA) in newly diagnosed COVID-19 patients.

Methods and Results

This is a cross-sectional, single center study with a total of 53 newly diagnosed COVID-19 patients (confirmed with polymerase chain reaction (PCR) test) and 63 age and sex-matched control subjects were included in the study. P wave dispersion, maximum P wave duration, and PWA were calculated manually from 12-lead ECG. Patients with COVID-19 more often had prolonged PWD, defined as PWD ≥ 36 ms compared to control group (37,7% vs 15,9%), (OR = 3,212; 95%CI 1,34 – 7,70; p = 0,007). There were no significant association between COVID-19 and prolonged P wave (defined as maximum P wave duration > 106 ms) (OR = 1,446; 95%CI 0,454 – 4,6; p = 0,531) and abnormal PWA (defined as any value of PWA outside 0 to 75°) (OR = 5,061; 95%CI 0,548 – 46,74; p = 0,115).

Conclusion

Our study showed that COVID-19 patients are more likely to have prolonged PWD compared to control patients. However, COVID-19 was not significantly associated with prolonged P wave and abnormal PWA. We believe that initial non-invasive evaluation of PWD may serve as a predictor of atrial arrhytmias often found in COVID-19 patients.

OR47. Index of Cardiac Electrophysiological Balance (iCEB) in Patients with COVID-19

Aims

We aimed to examine whether there is abnormal value of index of cardiac electrophysiological balance (iCEB=QT/QRS) in patients with confirmed coronavirus disease 2019 (COVID-19), which can predict ventricular arrhythmias (VAs), including non-Torsades de Pointes-like ventricular tachycardia/ventricular fibrillation (non-TdPs-like VT/VF) in low iCEB and Torsades de Pointes (TdPs) in high iCEB. We also investigated low voltage ECG among COVID-19 group.

Methods and Results

This is a cross-sectional, single center study with a total of 53 newly diagnosed COVID-19 patients (confirmed with polymerase chain reaction (PCR) test) and 63 age and sex-matched control subjects were included in the study. Electrocardiographic marker of iCEB were calculated manually from 12-lead ECG. Low voltage ECG defined as peak-to-peak QRS voltage less than 5 mm in all limb leads and less than 10 mm in all precordial leads. Patients with COVID-19 more often had low iCEB, defined as iCEB below 3.24 compared to control group (56.6% vs 11.1%), (OR = 10.435; 95%CI 4.015 – 27.123; p = 0.000). There were no significant association between COVID-19 and high iCEB, defined as iCEB above 5.24 (OR = 1.041; 95%CI 0.485 – 2.235; p = 0.917). There were no significant difference of the number of low voltage ECG between COVID-19 and control groups (15.1% vs 6.3%), (OR = 2.622; 95%CI 0.743 - 9.257, p = 0.123).

Conclusion

In this study showed that patients with COVID-19 are more likely to have low iCEB, suggesting that patients with COVID-19 may be proarrhytmic (towards non-TdPs-like VT/VF event), due to the alleged myocardial involvement in SARS-CoV-2 infection.

Arrhythmia Risk Profile and Ventricular Repolarization Indices in COVID-19 Patients: A Systematic Review and Meta-Analysis

INTRODUCTION

Coronavirus disease 2019 (COVID-19) has been associated with cardiac arrhythmias. Several electrocardiographic markers have been used to predict the risk of arrhythmia in patients with COVID-19. We aim to investigate the electrocardiographic (ECG) ventricular repolarization indices in patients with COVID-19.

METHODOLOGY

We performed a comprehensive systematic literature search from PubMed, EuropePMC, SCOPUS, Cochrane Central Database, and Google Scholar Preprint Servers. The primary endpoints of this search were: Tp-e (T-peak-to-T-end) interval, QTd (QT dispersion), and Tp-e/QTc ratio in patients with newly diagnosed COVID-19 from inception up until August 2020.

RESULTS

There were a total of 241 patients from 2 studies. Meta-analysis showed that Tp-e/QTc ratio was higher in COVID-19 group (mean difference 0.02 [0.01, 0.02], p < 0.001; I2: 18%,). Tp-e interval was more prolonged in COVID-19 group (mean difference 7.76 [3.11, 12.41], p < 0.001; I2: 80%) compared to control group. QT dispersion (QTd) also was increased in COVID-19 group (mean difference 1.22 [0.61, 1.83], p < 0.001 ; I2:30%).

CONCLUSIONS

Several electrocardiographic markers including Tp-e/QTc, Tp-e interval, and QTd are significantly increased in patients with COVID-19.

Small residual patent ductus arteriosus after surgical ligation in young adult: to close or not to close - a dilemmatic case report

Percutaneous transcatheter closure has gained acceptance for patent ductus arteriosus (PDA) management ever since its introduction, including the management residual left-to-right shunts following surgical ligations. It is preferred than the more invasive surgical closure. While large PDA is closed to prevent heart failure, the decision to close a small hemodynamically insignificant PDA is still a debatable issue. We present a case of percutaneous transcatheter closure of small residual left-to-right shunt PDA using HeartR™ Lifetech PDA occluder with instantaneous closure in an asymptomatic adult patient. The justification of closure was made based on the previous history of infective endocarditis, followed by PDA ligation and endarterectomy surgery, at 1.5 year before admission.

Transjugular Seldinger approach for permanent pacemaker implantation in octogenarian with inaccessible upper limbs venous system

In up to 13.7% of device implants, lead entry through the cephalic, axillary, or subclavian veins might be unfeasible. Transjugular permanent pacemaker (PPM) implantation may be considered as a bailout strategy in the difficult anatomy of conventional veins, before resorting to epicardial pacing lead, which requires general anesthesia and thoracotomy. We described a case report of a single chamber PPM implantation in an 83-year-old man using transjugular Seldinger approach without surgical cut down of the internal jugular vein, due to spasm, stenosis, and thrombosis of the upper limbs venous systems. Acceptable lead impedance and threshold were maintained during 2 months follow-up.