Increased Arrhythmia Risk in Long COVID: A Systematic Review and Meta-Analysis.

BACKGROUND

COVID-19 infection can cause significant long-term health problems for patients. While there is no universally accepted definition for long COVID, it is usually identified by persistent symptoms that extend past 4 weeks after the initial SARS-CoV-2 infection with no other explanation. The cardiovascular system is one of the most important systems involved in long COVID, and even asymptomatic patients have evidence of cardiovascular injury after COVID-19. This study aims to determine the long-term risk of developing cardiac arrhythmias after SARS-CoV-2 infection.

METHODS

A comprehensive systematic search on Scopus, PubMed, Science Direct, and Web of Science databases was performed on August 24th, 2025. Cohort articles consisting of a healthy control group with no history of COVID-19 infection and individuals who recovered from COVID-19 for at least 30 days were included. Hazard Ratio (HR) and 95% confidence intervals (CI) were estimated using random-effect models.

RESULTS

Fourteen studies were eligible for the meta-analysis. The overall arrhythmia risk was higher in patients with long COVID (HR: 1.74, 95% CI [1.39, 2.10], I 2 = 99.65%). Specific arrhythmias examined included atrial fibrillation (HR: 1.49, 95% CI [1.24, 1.73], I 2 = 98.57%), sinus tachycardia (HR: 1.69, 95% CI [1.21, 2.18], I 2 = 99.51%), sinus bradycardia (HR: 1.58, 95% CI [1.50, 1.66], I 2 = 65.80%), and ventricular arrhythmias (HR: 1.72, 95% CI [1.48, 1.95], I 2 = 96.89%). Patients with a more severe initial infection were at a higher risk of developing arrhythmias.

CONCLUSIONS

The risk of developing cardiac arrhythmias is increased after COVID-19 infection in the long term.