Features of cardiac arrhythmias in patients with acute st-segment elevation myocardial infarction who underwent COVID-19

Objective: to conduct a comparative assessment of the parameters of heart rhythm and conduction in patients with Covid-19 with acute ST-segment elevation myocardial infarction (STEMI) in the hospital and post-hospital treatment periods. Materials and methods. The study included 140 patients with STEMI, stratified into 2 groups: I - the main (52 people) patients with STEMI who had COVID-19 for 1.5-6 months before the development of acute coronary syndrome (ACS), II - the comparison group (88 people) with STEMI without COVID-19 in the anamnesis. All patients underwent percutaneous coronary intervention with stenting of a single infarct-related artery in the first 24 hours. Daily ECG monitoring was performed with an assessment of traditional heart rate and conduction parameters for 2-3 days, 9-11 days and after 6 months from the moment of the accident. Results. In the main group, in contrast to the control group, a shortening of the QT interval (7.7% vs. 0.0%), ventricular extrasystole (VES) of Lown grade IV A (25.0% vs. 7.9%) was more often recorded on 2-3 days. Supraventricular extrasystole (SVE; 92.0% vs. 65.4%), sinus arrhythmia (37.5% vs. 0.0%), supraventricular tachycardia (SVT; 7.9% vs. 0.0%) were more often recorded in group II on 2-3 days. During the hospital follow-up period, the retention of shortened QT (7.7% vs. 0.0%), predominance SVE (90.4% vs. 76.1%), sinus arrhythmia (48.1% vs. 29.5%), migration of the rhythm driver along the atria (15.3% vs. 0.0%), VES Lown grade IV A (9.6 % vs. 0.0%). In the control group, AV blockade of 1 deg. (15.9% vs. 3.8%), AV blockade of 2 deg. (4.5% vs. 0.0%), CA blockade (3.4% vs. 0.0%), QT prolongation (12.5% vs. 0.0%) were more often determined. By 6 months after STEMI, patients in the main group were more likely to have SVT (9.6% vs. 0.0%) and VES Lown grade IV A (7.6% vs. 0.0%). In the control group, AV blockade of 1 deg. (9.0% vs. 0.0%), CA blockade (3.4% vs. 0.0%) were registered. Conclusion. Patients with STEMI who had a history of COVID-19 and without COVID-19 had a multidirectional dynamics of heart rate and conduction parameters during the hospital and post-hospital follow-up periods. In patients who underwent COVID-19, there was a predominance of ventricular arrhythmias of high Lown gradations on 2-3 days of STEMI, an increase in supraventricular arrhythmias on days 9-11, an increase in supraventricular and ventricular arrhythmias of high Lown gradations and the absence of CA and AB disorders after 6 months. In the control group, there was a predominance of supraventricular and ventricular arrhythmias of low gradations according to Lown, a predominance of CA and AB conduction disorders on days 9-11 and 6 months after STEMI.

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