Use of Electrocardiographic Screening to Clear Athletes for Return to Sports Following COVID-19 Infection

• Published in: Mayo Clinic proceedings. Innovations, quality & outcomes Vol. 5; no. 2; pp. 368 - 376
• Main Authors: Erickson, Jacob L., Poterucha, Joseph T., Gende, Alecia, McEleney, Mark, Wencl, Corey M., Castaneda, Marisa, Gran, Lindsay, Luedke, Joel, Collum, Jill, Fischer, Karen M., Jagim, Andrew R.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.04.2021; Elsevier
• Subjects: Original; COVID-19; ECG; NCAA; BMI; BMI, body mass index; COVID-19, coronavirus disease 2019; ECG, electrocardiography; NCAA, National Collegiate Athletic Association
• ISSN: 2542-4548; 2542-4548
• DOI: 10.1016/j.mayocpiqo.2021.01.007

To quantify the occurrence rate of abnormal electrocardiographic (ECG) findings and symptoms following coronavirus disease 2019 (COVID-19) infection. In this retrospective analysis, we studied adult patients (>18 years old) who were participating in collegiate athletics and previously tested positive for COVID-19 between August 1, 2020, and December 30, 2020. The athletes underwent general examinations and ECG screening prior to being medically cleared for a return to sports following their COVID-19 diagnosis. Predetermined predictors were grouped into categorical variables including (1) sex, (2) symptom severity, and (3) body mass index (normal vs overweight [≥24 kg/m2]). These variables were used to examine differences of abnormal rates that occurred between different predictor categories. Of the 170 athletes screened, 6 (3.5%) presented with abnormal ECG findings and were referred to cardiologists. We found no evidence that sex, symptom severity, and body mass index category were associated with a higher rate of abnormal ECG findings (all P>.05). Greater severity of COVID-19 symptoms was associated with a higher percentage of ST depression, T-wave inversion, ST-T changes, and the presence of fragmented QRS complex. Loss of smell, loss of taste, headache, and fatigue were the most prevalent symptoms, with 38.8% (66), 36.5% (62), 32.9% (56), and 25.3% (43), respectively, of the 170 athletes reporting each symptom. Preliminary findings indicate a low risk of myocardial injury secondary to COVID-19 infection, with less than 4% of the 170 patients in our study presenting with abnormal ECG findings and a total of 16 patients (9.4%) requiring referral to a cardiologist. Although viral myocarditis was not detected in any athlete referred for cardiological assessment, 2 patients experienced effusive viral pericarditis.