Arrhythmias and electrocardiographic findings in Coronavirus disease 2019: A systematic review and meta-analysis

Sebastian Garcia-Zamora, Sharen Lee, Sohaib Haseeb, George Bazoukis, Gary Tse, Jesus Alvarez-Garcia, Enes Elvin Gul, Göksel Çinier, Bryce Alexander, Marcelo Martins Pinto-Filho, Tong Liu, Adrian Baranchuk

Research output: Contribution to journalArticlepeer-review

25 Citations (Scopus)


Background: Coronavirus disease 2019 (COVID-19) primarily causes lung infection, but recent studies have shown that cardiac involvement is associated with a worse prognosis. Objectives: We conducted a systematic review and meta-analysis to examine the prevalence of cardiac arrhythmias detected by the electrocardiogram and their relationships with adverse outcomes in patients with COVID-19. Methods: PubMed and Google were searched for studies that reported on cardiac arrhythmias and/or examined the relationship between arrhythmias and adverse outcomes. Results: Thirty studies with 12,713 participants were included in the systematic review, and 28 studies (n = 12,499) in the meta-analysis. The mean age was 61.3 ± 16.8 years; 39.3% were female. In 25 studies with 7578 patients, the overall prevalence of cardiac arrhythmias was 10.3% (95% confidence interval [CI]: 8.4%–12.3%). The most common arrhythmias documented during hospitalization were supraventricular arrhythmias (6.2%, 95% CI: 4.4%–8.1%) followed by ventricular arrhythmias (2.5%, 95% CI: 1.8%–3.1%). The incidence of cardiac arrhythmias was higher among critically ill patients (relative risk [RR]: 12.1, 95% CI: 8.5–17.3) and among non-survivors (RR: 3.8, 95%, CI: 1.7–8.7). Eight studies reported changes in the QT interval. The prevalence of QTc > 500 ms was 12.3% (95% CI: 6.9%–17.8%). ST-segment deviation was reported in eight studies, with a pooled estimate of 8.7% (95% CI: 7.3% to 10.0%). Conclusion: Our meta-analysis showed that QTc prolongation, ST-segment deviation, and various other cardiac arrhythmias were observed in patients hospitalized with COVID-19. The presence of cardiac arrhythmias was associated with a worse prognosis.

Original languageEnglish
Pages (from-to)1062-1074
Number of pages13
JournalPACE - Pacing and Clinical Electrophysiology
Issue number6
Publication statusPublished - Jun 2021
Externally publishedYes


  • COVID-19
  • ECG
  • atrial fibrillation
  • ventricular tachyarrhythmias


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