Subject(s)
Arrhythmias, Cardiac , COVID-19 , Cardiology Service, Hospital , Electrocardiography, Ambulatory , Electrophysiologic Techniques, Cardiac/methods , Telemedicine , Antiviral Agents/pharmacology , Arrhythmias, Cardiac/epidemiology , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/therapy , COVID-19/epidemiology , COVID-19/therapy , Cardiology Service, Hospital/organization & administration , Cardiology Service, Hospital/trends , Electrocardiography, Ambulatory/instrumentation , Electrocardiography, Ambulatory/methods , Forecasting , Humans , International Cooperation , Organizational Innovation , SARS-CoV-2 , Societies, Medical/trends , Telemedicine/methods , Telemedicine/organization & administration , Telemedicine/trendsSubject(s)
Arrhythmias, Cardiac/diagnosis , Betacoronavirus , Coronavirus Infections/complications , Electrocardiography , Pneumonia, Viral/complications , Telemedicine/organization & administration , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/therapy , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Humans , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , SARS-CoV-2Subject(s)
Arrhythmias, Cardiac , Coronavirus Infections , Pandemics , Pneumonia, Viral , Remote Consultation/methods , Telemedicine/organization & administration , Telemetry , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/epidemiology , Betacoronavirus , COVID-19 , Communicable Disease Control/organization & administration , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Electrophysiologic Techniques, Cardiac/methods , Electrophysiologic Techniques, Cardiac/trends , Humans , International Cooperation , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2 , Telemetry/instrumentation , Telemetry/methodsABSTRACT
Coronavirus disease 2019 (COVID-19) has presented substantial challenges to patient care and impacted health care delivery, including cardiac electrophysiology practice throughout the globe. Based upon the undetermined course and regional variability of the pandemic, there is uncertainty as to how and when to resume and deliver electrophysiology services for arrhythmia patients. This joint document from representatives of the Heart Rhythm Society, American Heart Association, and American College of Cardiology seeks to provide guidance for clinicians and institutions reestablishing safe electrophysiological care. To achieve this aim, we address regional and local COVID-19 disease status, the role of viral screening and serologic testing, return-to-work considerations for exposed or infected health care workers, risk stratification and management strategies based on COVID-19 disease burden, institutional preparedness for resumption of elective procedures, patient preparation and communication, prioritization of procedures, and development of outpatient and periprocedural care pathways.
Subject(s)
Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/therapy , Cardiology , Coronavirus Infections/epidemiology , Delivery of Health Care , Electrophysiologic Techniques, Cardiac , Pneumonia, Viral/epidemiology , Ambulatory Care , American Heart Association , Betacoronavirus , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Decision Making, Shared , Health Personnel , Humans , Mass Screening , Organizational Policy , Pandemics/prevention & control , Patient Selection , Personal Protective Equipment/supply & distribution , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , Return to Work , Risk Assessment , SARS-CoV-2 , Telemedicine , United States/epidemiologyABSTRACT
Coronavirus disease 2019 (COVID-19) is a global pandemic that is wreaking havoc on the health and economy of much of human civilization. Electrophysiologists have been impacted personally and professionally by this global catastrophe. In this joint article from representatives of the Heart Rhythm Society, the American College of Cardiology, and the American Heart Association, we identify the potential risks of exposure to patients, allied healthcare staff, industry representatives, and hospital administrators. We also describe the impact of COVID-19 on cardiac arrhythmias and methods of triage based on acuity and patient comorbidities. We provide guidance for managing invasive and noninvasive electrophysiology procedures, clinic visits, and cardiac device interrogations. In addition, we discuss resource conservation and the role of telemedicine in remote patient care along with management strategies for affected patients.
Subject(s)
Arrhythmias, Cardiac/etiology , Betacoronavirus , Coronavirus Infections/epidemiology , Electrocardiography , Pandemics , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , American Heart Association , Arrhythmias, Cardiac/therapy , COVID-19 , Cardiology , Cardiopulmonary Resuscitation , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Humans , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , SARS-CoV-2 , Societies, Medical , Telemedicine , Triage , United StatesSubject(s)
Arrhythmias, Cardiac/epidemiology , Coronavirus Infections/epidemiology , Global Health , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Subacute Care/organization & administration , Telemedicine/organization & administration , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/therapy , COVID-19 , Cause of Death , Comorbidity , Coronavirus Infections/prevention & control , Female , Humans , Inpatients/statistics & numerical data , Long-Term Care/organization & administration , Male , Monitoring, Physiologic/methods , Outpatients/statistics & numerical data , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , Program Evaluation , Risk Assessment , Survival AnalysisABSTRACT
Coronavirus disease 2019 (COVID-19) is a global pandemic that is wreaking havoc on the health and economy of much of human civilization. Electrophysiologists have been impacted personally and professionally by this global catastrophe. In this joint article from representatives of the Heart Rhythm Society, the American College of Cardiology, and the American Heart Association, we identify the potential risks of exposure to patients, allied healthcare staff, industry representatives, and hospital administrators. We also describe the impact of COVID-19 on cardiac arrhythmias and methods of triage based on acuity and patient comorbidities. We provide guidance for managing invasive and noninvasive electrophysiology procedures, clinic visits, and cardiac device interrogations. In addition, we discuss resource conservation and the role of telemedicine in remote patient care along with management strategies for affected patients.
Subject(s)
Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/therapy , Betacoronavirus , Coronavirus Infections/prevention & control , Electrocardiography , Electrophysiologic Techniques, Cardiac , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Arrhythmias, Cardiac/etiology , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Humans , Infection Control/organization & administration , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Telemedicine/organization & administration , Triage/organization & administrationABSTRACT
BACKGROUND: Cardiovascular and arrhythmic events have been reported in hospitalized COVID-19 patients. However, arrhythmia manifestations and treatment strategies used in these patients have not been well-described. We sought to better understand the cardiac arrhythmic manifestations and treatment strategies in hospitalized COVID-19 patients through a worldwide cross-sectional survey. METHODS: The Heart Rhythm Society (HRS) sent an online survey (via SurveyMonkey) to electrophysiology (EP) professionals (physicians, scientists, and allied professionals) across the globe. The survey was active from March 27 to April 13, 2020. RESULTS: A total of 1197 respondents completed the survey with 50% of respondents from outside the USA, representing 76 countries and 6 continents. Of respondents, 905 (76%) reported having COVID-19-positive patients in their hospital. Atrial fibrillation was the most commonly reported tachyarrhythmia whereas severe sinus bradycardia and complete heart block were the most common bradyarrhythmias. Ventricular tachycardia/ventricular fibrillation arrest and pulseless electrical activity were reported by 4.8% and 5.6% of respondents, respectively. There were 140 of 631 (22.2%) respondents who reported using anticoagulation therapy in all COVID-19-positive patients who did not otherwise have an indication. One hundred fifty-five of 498 (31%) reported regular use of hydroxychloroquine/chloroquine (HCQ) + azithromycin (AZM); concomitant use of AZM was more common in the USA. Sixty of 489 respondents (12.3%) reported having to discontinue therapy with HCQ + AZM due to significant QTc prolongation and 20 (4.1%) reported cases of Torsade de Pointes in patients on HCQ/chloroquine and AZM. Amiodarone was the most common antiarrhythmic drug used for ventricular arrhythmia management. CONCLUSIONS: In this global survey of > 1100 EP professionals regarding hospitalized COVID-19 patients, a variety of arrhythmic manifestations were observed, ranging from benign to potentially life-threatening. Observed adverse events related to use of HCQ + AZM included prolonged QTc requiring drug discontinuation as well as Torsade de Pointes. Large prospective studies to better define arrhythmic manifestations as well as the safety of treatment strategies in COVID-19 patients are warranted.