Cor Vasa 2026, 68(2):137-142 | DOI: 10.33678/cor.2025.107

(Assessment of the possible impact of COVID-19 infection on the autonomic nervous system in the pediatric population)

Martina Šišáková^a, Kateřina Helánová^a, Irena Andršová^a, Tomáš Novotný^a, Jiří Pařenica^a, Lukáš Homola^b, Martin Sihlovec^b

^a Interní kardiologická klinika, Lékařská fakulta Masarykovy univerzity a Fakultní nemocnice Brno, Brno, Česká republika

^b Klinika dětských infekčních nemocí, Lékařská fakulta Masarykovy univerzity a Fakultní nemocnice Brno, Brno, Česká republika

Objective: Autonomic changes, such as increased sympathetic manifestations, are a common complication of acute viral infections. Our study considered the possibility that SARS-CoV-2 infection leads to long-term abnormalities of the autonomic nervous system that persist even after the acute and subacute phases of the infection have resolved. The aim of this study was to assess the effect of COVID-19 infection on autonomic nervous system modulation in children.

Methods: A total of 165 children (89 girls) 6.7 to 18.6 year old were enrolled. Each participant underwent a postural provocation test (supine and standing positions) during which ECG recording was taken to analyze autonomic nervous system modulation. A single blood sample was also collected. ECG recordings were analyzed to assess SDNN (standard deviation of all RR intervals) and RMSSD (root mean square of successive differences between RR intervals). In blood samples, antibodies against the nucleocapsid (N) protein and the spike (S) protein were measured. Based on laboratory results and medical history, children were categorized according to whether they had experienced a COVID-19 infection.

Results: Of the 153 children with complete data, 80 had a confirmed history of COVID-19 infection. Notably, 23% of antibody-positive children were unaware of having had the infection. There were no significant differences in resting heart rate or heart rate changes during the postural test between children with and without prior COVID-19 infection. Similarly, no significant differences were found in SDNN or RMSSD values.

Conclusion: Our findings suggest that COVID-19 infection does not lead to significant alterations in autonomic nervous system modulation in children.

Keywords: Autonomic nervous system, in children, COVID-19 infection, Postural tests

Received: August 1, 2025; Revised: August 1, 2025; Accepted: October 13, 2025; Prepublished online: June 2, 2012; Published: May 20, 2026  Show citation