Objective: To quantify the occurrence rate of abnormal ECG findings and symptoms following COVID-19 infection . Patients: Adult patients (> 18 years old) who were participating in collegiate athletics and previously tested positive for COVID-19 between August 2020 to November 2020 .

Methods: In this retrospective study, we report findings of electrocardiogram (ECG) testing to screen athletes for cardiac abnormalities following COVID-19 . Athletes underwent general examinations and ECG screening prior to being medically cleared for a return to sport following COVID-19 . Predetermined predictors were grouped into categorical variables including : 1) Sex; 2) Symptom severity; and 3) BMI (normal vs. overweight => 24 kg∙m-2). These were used to examine differences of abnormal rates occurred between different predictor categories .

Results: Of the 170 athletes screened, 6 (3.5 %) presented with abnormal ECG criteria and were referred to cardiology . We found no evidence that symptom severity, sex and BMI category were associated with a higher rate of abnormal ECG (p> 0.05). Greater severity of COVID-19 symptoms were associated with higher percentage of ST depression, T-wave inversion, ST-T changes and presence of fQRS . Loss of smell, loss of taste, headache and sore throat were the most prevalent symptoms with 32.9% , 38.8% , 36.5% and 25.3% of athletes reporting each symptom, respectively .

Conclusions: Preliminary findings indicate a low risk of myocardial injury secondary to COVID-19 infection with less than4% of patients presenting with abnormal ECG and 10% requiring referral to a cardiologist . While viral myocarditis was not demonstrated in any athlete referred for cardiology assessment, two patients developed effusative viral pericarditis.