Applicability of heart rate variability for cardiac autonomic assessment in long-term COVID patients: A systematic review

Ádrya Aryelle Ferreira; Raphael Martins de Abreu; Rodrigo Souza Teixeira; Herculano Ribeiro da Silva Neto; Pedro Igor Lustosa Roriz; Matheus Sobral Silveira; Fabianne Maisa de Novaes Assis Dantas; Armele Dornelas De Andrade; Paulo Adriano Schwingel; Victor Ribeiro Neves

doi:10.1016/j.jelectrocard.2023.12.002

Applicability of heart rate variability for cardiac autonomic assessment in long-term COVID patients: A systematic review

J Electrocardiol. 2024 Jan-Feb:82:89-99. doi: 10.1016/j.jelectrocard.2023.12.002. Epub 2023 Dec 12.

Affiliations

¹ Postgraduation Program in Functional Rehabilitation and Performance (PPGRDF), UPE, Petrolina, PE, Brazil; Department of Physiotherapy, University of Pernambuco (UPE), Petrolina, PE, Brazil.
² LUNEX University, International University of Health, Exercise & Sports S.A. 50, Department of Physiotherapy, 50 Avenue du Parc des Sports, L-4671 Differdange, Luxembourg; LUNEX ASBL Luxembourg Health & Sport Sciences Research Institute, 50 Avenue du Parc des Sports, L-4671 Differdange, Luxembourg. Electronic address: raphaelmartins.abreu@gmail.com.
³ Department of Physiotherapy, University of Pernambuco (UPE), Petrolina, PE, Brazil.
⁴ Postgraduation Program in Functional Rehabilitation and Performance (PPGRDF), UPE, Petrolina, PE, Brazil; Department of Nutrition, University of Pernambuco (UPE), Petrolina, PE, Brazil.
⁵ Postgraduation Program in Physiotherapy of the Federal University of Pernambuco (UFPE), Recife, PE, Brazil.

PMID: 38103537
DOI: 10.1016/j.jelectrocard.2023.12.002

Abstract

Purpose: To carry out a systematic review to determine the main methods used to study the heart rate variability (HRV) in individuals after the acute phase of COVID-19.

Methods: The study followed the Preferred Items for Reporting for Systematic Reviews and Meta-Analyses (PRISMA) statement. PubMed, Web of Science, Scopus and CINAHAL electronic databases were searched from the inception to November 2022. The studies were included if they used HRV assessment based on linear and non-linear methods in long-term COVID-19 patients. Review studies, theses and dissertations, conference abstracts, longitudinal studies, studies conducted on animals and studies that included individuals in the acute phase of the COVID-19 were excluded. The methodological quality of the studies was analyzed using the Joanna Briggs Institute's critical evaluation checklist for cross-sectional analytical studies.

Results: HRV was mainly assessed using 24-h Holter monitoring in 41.6% (5/12) of the studies, and 12‑lead ECG was used in 33.3% (4/12). Regarding the type of assessment, 66.6% (8/12) of the studies only used linear analysis, where 25% (3/12) used analysis in the time domain, and 41.6% (5/12) used both types. Non-linear methods were combined with the previously cited linear method in 25% (3/12) of the studies. Moreover, 50% (6/12) of the studies demonstrated post-COVID-19 autonomic dysfunction, with an increase in the predominance of cardiac sympathetic modulation. The average score of the evaluation checklist was 6.6, characterized as having reasonable methodological quality.

Conclusion: 24-h Holter and 12‑lead ECG are considered effective tools to assess HRV in post-COVID-19 patients. Furthermore, the findings reveal diverse effects of COVID-19 on the autonomic nervous system's sympathovagal balance, which might be influenced by secondary factors such as disease severity, patients' overall health, evaluation timing, post-infection complications, ventilatory functions, and age.

Keywords: Autonomic dysfunction; Autonomic nervous system; COVID-19; Heart rate variability; Post-COVID.

Publication types

Systematic Review
Review

MeSH terms

Autonomic Nervous System
COVID-19 / complications
Cross-Sectional Studies
Electrocardiography*
Heart Rate*
Humans
Post-Acute COVID-19 Syndrome* / diagnosis