BACKGROUND: Sars-CoV-2 infection may lead to clinical manifestation, occasionally related to changes in the autonomic nervous system (ANS). One of the most widely used methods to assess the ANS and the sympatho-vagal balance in the clinical setting is heart rate variability (HRV). In athletes, it is useful for diagnosing impairments in performance, in recovery after acute exertion and/or a state of chronic overtraining. The aim of the study was to test for changes in HRV a population of athletes with recent Sars-CoV-2 infection and no evidence of long-COVID syndrome. METHODS: A retrospective cohort of competitive athletes who had undergone a 24-hour ambulatory ECG monitoring (Holter) prior to Sars-CoV-2 infection, on indication for competitive sport clearance (usually arrhythmias), and who repeated HOLTER after infection. No one showed signs of cardiovascular pathology or clinical evidence of Long-COVID. HOLTER registration was performed within 60 days after COVID-test positivity (swab). The main HRV parameters were collected and analyzed (in both time and frequency domain), over the 24 hours and over 5-minute intervals of relevance: during night rest (2 hours before awakening), during a standardized training session and after the start of recovery (after training). RESULTS: The cohort consisted of 21 competitive athletes (age 19.1±8.3, M:F 3:1); 8 (38.1%) with asymptomatic COVID course and 13 (61.9%) paucisymptomatic. In both the time and frequency domains, there were no statistically significant differences between the various HRV parameters measured before and after infection, either in the total cohort or in the subgroups (paucisymptomatic/asymptomatic). Furthermore, no difference in the main HRV parameters related to vagal hypertone was identified. CONCLUSIONS: HRV did not appear to be impaired in athletes after an asymptomatic or paucisymptomatic SARS-CoV-2 infection. Young athletes without long-COVID symptoms did not manifest nor an altered sympatho-vagal balance neither a predominant vagal tone after infection.
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