The contribution of psychological distress to resting palpitations in patients recovering from severe coronavirus disease 2019

Background: Increasing numbers of patients have recovered from severe coronavirus disease 2019 (COVID-19) in Wuhan, China. This study aimed to evaluate the association of psychological distress with resting palpitations in those recovered patients. Methods: In this prospective cohort study, consecutive patients who recovered from severe COVID-19 and complained of resting palpitations were included. Dynamic electrocardiogram (ECG) was continuously monitored for 2 hours while patients were at rest. A survey using palpitation frequency scale and the Hospital Anxiety and Depression Scale (HADS) was administrated to all participants. Results: Of the 289 consecutive patients recovering from severe COVID-19, 24 patients (8.3%) suffered resting palpitations symptoms, and 22 patients were finally included. Dynamic ECG monitoring showed that 18 (81.8%) patients had tachyarrhythmias, of which, the most common was sinus tachycardia (17/22, 77.3%). However, patients with sinus tachycardia showed a similar frequency of palpitations episodes compared to those without sinus tachycardia. Anxiety (68.2%) and depression (59.1%) were prevalent among these recovered patients. Patients with anxiety or depression symptoms were respectively associated with a higher frequency of palpitations episodes than those without. In addition, both HADS-anxiety score (r =0.609, P<0.01) and HADS-depression score (r =0.516, P=0.01) were positively related to the frequency of palpitations episodes, respectively. Conclusion: Symptom of resting palpitations, manifested mainly by sinus tachycardia, is not uncommon in patients recovering from severe COVID-19. Psychological distress (anxiety and depression) may be responsible, at least in part, for the resting palpitations symptoms.