Small molecule inhibitor CRT0066101 inhibits cytokine storm syndrome in a mouse model of lung injury.

Pneumonia is an acute inflammation of the lungs induced by pathogenic microorganisms, immune damage, physical and chemical factors, and other factors, and the latest outbreak of novel coronavirus pneumonia is also an acute lung injury (ALI) induced by viral infection. However, there are currently no effective treatments for inflammatory cytokine storms in patients with ALI/acute respiratory distress syndrome (ARDS). Protein kinase D (PKD) is a highly active kinase that has been shown to be associated with the production of inflammatory cytokines. Therefore, small-molecule compounds that inhibit PKD may be potential drugs for the treatment of ALI/ARDS. In the present study, we evaluated the ability of the small-molecule inhibitor CRT0066101 to attenuate lipopolysaccharide (LPS)-induced inflammatory cytokine production through in vitro cell experiments and a mouse pneumonia model. We found that CRT0066101 significantly reduced the protein and mRNA levels of LPS-induced cytokines (e.g., IL-6, TNF-α, and IL-1ß). CRT0066101 inhibited MyD88 and TLR4 expression and reduced NF-κB, ERK, and JNK phosphorylation. CRT0066101 also reduced NLRP3 activation, inhibited the assembly of the inflammasome complex, and attenuated inflammatory cell infiltration and lung tissue damage. Taken together, our data indicate that CRT0066101 exerts anti-inflammatory effects on LPS-induced inflammation through the TLR4/MyD88 signaling pathway, suggesting that CRT0066101 may have therapeutic value in acute lung injury and other MyD88-dependent inflammatory diseases.

My journey to this place called the RAC: Reflections on a movement in critical race thought and critical race hope in higher education

This chapter recounts the story of how I came to design a Research Apprenticeship Course at UCLA-what we call the RAC. I lay out the origin story of the RAC dating back to early collaborations with Arturo Madrid of the Tomas Rivera Policy Research Center and the Ford Foundation Family of Fellows in the mid to late 1980s. These collaborations helped me establish the blueprint for the RAC as an academic counterspace-a space centered on identifying, analyzing, and challenging race and racism in education. We did this by extending Critical Race Theory (CRT) in the Law to the fields of Education, Race and Ethnic Studies, Women of Color Feminist Theories, and Freirean Critical Theory. My journey weaves in the stories of former students and their relationship to the RAC and how the RAC impacted their research, teaching, and service. Prologue: This essay has an interesting origin story. The two editors of this special issue, Professors Laurence Parker and Maria Ledesma contacted me in early 2020 and asked if I would write a reflective story of my Research Apprenticeship Course (RAC). To move the process along, Professors Parker and Ledesma came to the RAC and spoke to our students on March 13, 2020, at the University of California, Los Angeles (UCLA). As a result of the COVID-19 pandemic, UCLA shut down all on-campus instruction on Wednesday, March 11, and moved online. The March 13 RAC was my first attempt at online instruction. If I recall, we had around 30 students attending online via Zoom, and five were in our Moore Hall classroom. During the RAC, Professors Parker and Ledesma asked the students to send their reflections or their stories of the RAC. They also sent out an email to former students asking for their reflections. After the March 13th RAC, I wrote the first draft of this article. Professors Parker and Ledesma then inserted the selected reflective quotes they received from the students into the narrative. I then weaved the quotes into the story of the RAC. In the Critical Race Counterstory tradition, the following narrative reflects the collaboration of Professors Parker and Ledesma, my former students, and myself. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Health information equity: Rebalancing healthcare collections for racial diversity in UK public service contexts

COVID-19 illustrated health disparities experienced by racially minoritised people, with heightened risks faced by Black and South Asian communities lending the issue transparency and urgency. Despite efforts to decolonise medical education, deficits in racial representation in research and resources remain. This study investigates the potential and imperatives for healthcare information services to contribute to health equity through their collections. The literature analysis explores collection management, decolonisation, social justice in librarianship, and Critical Race Theory (CRT) as a framework for change in information contexts. A survey of UK National Health Service (NHS) librarians provides a snapshot of awareness of health information inequity. Semi-structured interviews explore information professionals' experiences of anti-racism in the system. The findings indicate strong engagement with the need for equitable resources but highlight some barriers to success. Opportunities identified include potential for addressing systemic racism in collection policy, capability of information services to influence, or engage in, authorship and publishing to address gaps, and the need for race-based data standards in healthcare. Synthesis of the findings through a framework of CRT tenets illustrates the relevance and utility of CRT as a tool for pursuit of equity in information practice, scholarship, and education.

Critical race studies in qualitative research: a review and future directions

In 2021, former President Donald Trump issued a presidential memo halting and prohibiting "divisive" and "anti-American propaganda" in federal contracting--described as "any training on 'critical race theory,' 'white privilege,' or any other training and propaganda effort that teaches or suggests either (1) that the United States is an inherently racist or evil country or (2) that any race or ethnicity is inherently racist or evil". Unsurprisingly, the concerted attack against CRT grossly misunderstands what CRT is and often equates teaching about individual racism, privilege, unconscious bias, systemic racism, and U.S. history with the teaching of CRT. As of October 2021, 28 states have restricted education on racism, bias, and the teaching of CRT. [ FROM AUTHOR]

Design of Mid-Q Response: A prospective, randomized trial of adaptive cardiac resynchronization therapy in Asian patients.

Aims: The aim of the Mid-Q Response study is to test the hypothesis that adaptive preferential left ventricular-only pacing with the AdaptivCRT algorithm has superior clinical outcomes compared to conventional cardiac resynchronization therapy (CRT) in heart failure (HF) patients with moderately wide QRS duration (≥120 ms and <150 ms), left bundle branch block (LBBB), and normal atrioventricular (AV) conduction (PR interval ≤200 ms). Methods: This prospective, multi-center, randomized, controlled, clinical study is being conducted at approximately 60 centers in Asia. Following enrollment and baseline assessment, eligible patients are implanted with a CRT system equipped with the AdaptivCRT algorithm and are randomly assigned in a 1:1 ratio to have AdaptivCRT ON (Adaptive Bi-V and LV pacing) or AdaptivCRT OFF (Nonadaptive CRT). A minimum of 220 randomized patients are required for analysis of the primary endpoint, clinical composite score (CCS) at 6 months post-implant. The secondary and ancillary endpoints are all-cause and cardiovascular death, hospitalizations for worsening HF, New York Heart Association (NYHA) class, Kansas City Cardiomyopathy Questionnaire (KCCQ), atrial fibrillation (AF), and cardiovascular adverse events at 6 or 12 months. Conclusion: The Mid-Q Response study is expected to provide additional evidence on the incremental benefit of the AdaptivCRT algorithm among Asian HF patients with normal AV conduction, moderately wide QRS, and LBBB undergoing CRT implant.

Midline peripheral catheters inserted in the superficial femoral vein at mid-thigh: Wise choice in COVID-19 acute hypoxemic respiratory failure patients with helmet continuous positive airway pressure.

BACKGROUND: During coronavirus disease 2019 (COVID-19) pandemic, Helmet Continuous Positive Airway Pressure (h-CPAP) has been widely used to treat Acute Hypoxemic Respiratory Failure (AHRF). In COVID-19 patients undergoing h-CPAP a simple short peripheral catheter could be insufficient. According to the European Recommendations for Proper Indication and Use of Peripheral venous access consensus, a stable peripheral Vascular Access Device is indicated for intravenous treatment compatible with the peripheral route scheduled for more than 1 week. OBJECTIVE: The aim of this prospective study was to evaluate the performance and the potential complications of superficial femoral midline catheters (SFMC) inserted in the Superficial Femoral Vein by direct Seldinger technique with peripheral tip (Arrow®, Teleflex; 20 cm length four FR single lumen and seven FR dual lumen) in AHRF COVID-19 patient. Complications were divided in early (accidental puncture of superficial femoral artery (APSFA); accidental saphenous nerve puncture (ASNP); bleeding) and late (Catheter Related Thrombosis (CRT); Catheter-Related Bloodstream Infections (CRBSI); Accidental Removal (AR); persistent withdrawal occlusion (PWO)). METHODS: From 1st October 2020 to 30th June 2021 we conducted a prospective observational study in COVID-19 sub-intensive wards at Luigi Sacco Hospital (Milan). RESULTS: Hundred seventy five SFMC (mean dwell time 11.1 ± 9.8 days) were implanted in COVID-19 patients, 107 (61.1%) during h-CPAP treatment (10.5 ± 8.9 days), the remaining 68 (38.9%) in patients with severe disease. We recorded two minor immediate/early complications (APSFA without sequelae) and no major complications.The long-term follow-up registered four CRBSI (2.3%-2.5/1000 catheters days (CD)), five CRT (2.9%: 2.6/1000 CD), 22 AR (12.6%; 11.4/1000 CD), 38 PWO (36.5%), 34 of which occurred due to fibroblastic sleeve (32.7%). CONCLUSIONS: SFMC proved to be safe, easy and time-saving. It could be implemented, after a careful benefits and risks evaluation, in particular settings such as h-CPAP, delirium, bleeding risk factors and palliative care patients.

Effects of COVID-19 lockdown on arrhythmias in patients with implantable cardioverter-defibrillators in southern Italy.

Background: The effects of lockdown on non-COVID patients are varied and unexpected. The aim is to evaluate the burden of cardiac arrhythmias during a lockdown period because of COVID-19 pandemics in a population implanted with cardiac defibrillators and followed by remote monitoring. Methods: In this retrospective, multicentre cohort study, we included 574 remotely monitored implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy-defibrillator (CRT-D) recipients implanted before January 1, 2019, at seven hospitals in the Campania region, comparing the burden of arrhythmias occurred during the lockdown period because of COVID-19 epidemics (from March 9 to May 1, 2020) with the arrhythmias burden of the corresponding period in 2019 (reference period). Data collection was performed through remote monitoring. Results: During the lockdown period, we observed ventricular tachyarrhythmias (ventricular tachycardia or fibrillation) in 25 (4.8%) patients while in seasonal reference period we documented ventricular tachyarrhythmias in 12 (2.3%) patients; the comparison between the periods is statistically significant (P < .04). Atrial arrhythmias were detected in 38 (8.2%) subjects during the lockdown period and in 24 (5.2%) during the reference period (P < .004). Conclusion: In seven hospitals in the Campania region, during the pandemic lockdown period, we observed a higher burden of arrhythmic events in ICD/CRT-D patients through device remote monitoring.

My journey to this place called the RAC: Reflections on a movement in critical race thought and critical race hope in higher education

This chapter recounts the story of how I came to design a Research Apprenticeship Course at UCLA-what we call the RAC. I lay out the origin story of the RAC dating back to early collaborations with Arturo Madrid of the Tomas Rivera Policy Research Center and the Ford Foundation Family of Fellows in the mid to late 1980s. These collaborations helped me establish the blueprint for the RAC as an academic counterspace-a space centered on identifying, analyzing, and challenging race and racism in education. We did this by extending Critical Race Theory (CRT) in the Law to the fields of Education, Race and Ethnic Studies, Women of Color Feminist Theories, and Freirean Critical Theory. My journey weaves in the stories of former students and their relationship to the RAC and how the RAC impacted their research, teaching, and service. PROLOGUE This essay has an interesting origin story. The two editors of this special issue, Professors Laurence Parker and Maria Ledesma contacted me in early 2020 and asked if I would write a reflective story of my Research Apprenticeship Course (RAC). To move the process along, Professors Parker and Ledesma came to the RAC and spoke to our students on March 13, 2020, at the University of California, Los Angeles (UCLA). As a result of the COVID-19 pandemic, UCLA shut down all on-campus instruction on Wednesday, March 11, and moved online. The March 13 RAC was my first attempt at online instruction. If I recall, we had around 30 students attending online via Zoom, and five were in our Moore Hall classroom. During the RAC, Professors Parker and Ledesma asked the students to send their reflections or their stories of the RAC. They also sent out an email to former students asking for their reflections. After the March 13(th) RAC, I wrote the first draft of this article. Professors Parker and Ledesma then inserted the selected reflective quotes they received from the students into the narrative. I then weaved the quotes into the story of the RAC. In the Critical Race Counterstory tradition, the following narrative reflects the collaboration of Professors Parker and Ledesma, my former students, and myself.

Hair Cortisol, Perceived Stress, and the Effect of Group Dynamics: A Longitudinal Study of Young Men during Compulsory Military Training in Lithuania.

Previous research shows a nonlinear dependency between hair cortisol concentrations and perceived stress levels. This may be due to stress being targeted at the individual level despite it also being a social phenomenon which is often affected by group dynamics. Therefore, the objective of this study was to determine the influence of perceived stress on the hair cortisol level, considering the impact of the variables of group dynamics (interpersonal, task, and norm cohesion). Information was collected on 11 groups of, in total, 112 young men in three phases of time during their compulsory military training (covering nine months in total). The classification and regression tree (C&RT) method was used to predict hair cortisol concentrations in groups. The results show that the variability of the hair cortisol level in young men groups can be explained by perceived stress only when the groups were in formation process (47.7% normalised importance in Model 1) and when the groups were working on their final tasks (37.80% normalised importance in Model 3); meanwhile, the importance of perceived stress in explaining hair cortisol concentrations is low when the group is in a routine period of a group life-span (28.9% normalised importance in Model 2). Interpersonal cohesion (normalised importance 100% in Model 1 and 80.0% in Model 3) and task cohesion (normalised importance 78.6% in Model 2) were the most important predictors in the study area. These results point to the importance of the elements of group dynamics when it comes to explaining the nature of hair cortisol as accumulated stress biomarkers in young men.

A novel survival algorithm in COVID-19 intensive care patients: the classification and regression tree (CRT) method

AJOL : Background/aim: The present study aimed to create a decision tree for the identification of clinical, laboratory and radio- logical data of individuals with COVID-19 diagnosis or suspicion of Covid-19 in the Intensive Care Units of a Training and Research Hospital of the Ministry of Health on the European side of the city of Istanbul. Materials and methods: The present study, which had a retrospective and sectional design, covered all the 97 patients treated with Covid-19 diagnosis or suspicion of COVID-19 in the intensive care unit between 12 March and 30 April 2020. In all cases who had symptoms admitted to the COVID-19 clinic, nasal swab samples were taken and thoracic CT was per- formed when considered necessary by the physician, radiological findings were interpreted, clinical and laboratory data were included to create the decision tree. Results: A total of 61 (21 women, 40 men) of the cases included in the study died, and 36 were discharged with a cure from the intensive care process. By using the decision tree algorithm created in this study, dead cases will be predicted at a rate of 95%, and those who survive will be predicted at a rate of 81%. The overall accuracy rate of the model was found at 90%. Conclusions: There were no differences in terms of gender between dead and live patients. Those who died were older, had lower MON, MPV, and had higher D-Dimer values than those who survived

Impact of COVID-19 on Power System Load: The case from Oman

Due to the COVID-19 pandemic, the governments around the world were compelled to reduce business activity and took measures in response to minimize the impact of coronavirus. Under this condition the people lifestyle has been changed due to lockdown restrictions and other measures. Hence the electricity sector significantly affected under circumstance of COVID-19. The system demand and total energy consumptions in network is impacted by COVID-19. The main aim this paper is to review, analyze the weak links in the system during the COVID-19 time by comparing the load profiles at different load schedules with respect to different costumers. The analysis on the system load is as considered for the year 2019 of April and May months and compare with the same period of year 2020. However, there could be a difference in ambient weather conditions, which also will reflect on system load, the long period load and analyze the overall effect to minimize such weather-related variations effect. Therefore, this study reviews the impact of COVID-19 on one of the power systems loads in Oman. The results show that the peak load reduction, effective utilization of the operation and control on power system.

Single-Pass VDD Pacing Lead for Cardiac Resynchronization Therapy: A Reliable Alternative.

(1) Background: Cardiac resynchronization therapy (CRT) systems can be simplified by excluding the atrial lead and using a Ventricular-Dual-Dual (VDD) pacing lead. Possible disadvantages might include atrial undersensing and Ventricular-Ventricular-Inhibition (VVI) pacing. Because literature data concerning these systems are scarce, we analyzed their benefits and technical safety. (2) Methods: this retrospective study compared 50 patients implanted with VDD-CRT systems (group A), mainly because of unfavorable venous anatomy concerning the complication rate, with 103 subjects with Dual-Dual-Dual (DDD)-CRT systems (group B) implanted during 2000-2016 and 49 (group C) during 2016-2020. To analyze the functional parameters of the devices, we selected subgroups of 27 patients (subgroup A) and 47 (subgroup B) patients with VDD-CRT in 2000-2016, and 36 subjects (subgroup C) with DDD-CRT implanted were selected in 2017-2020. (3) Results: There was a trend of a lower complication rate with VDD-CRT systems, especially concerning infections during 2000-2016 (p = 0.0048), but similar results were obtained after rigorous selection of patients and employment of an upgraded design of devices/leads. With a proper device programing, CRT pacing had similar results, atrial undersensing being minimal (p = 0.65). For VDD-systems, VVI pacing was recorded only 1.7 ± 2.24% of the time. (4) Conclusions: In patients with a less favorable venous anatomy, VDD-CRT systems may represent a safe alternative regarding complications rates and functional parameters.

Advances in cardiac resynchronization and implantable cardioverter/defibrillator therapy: Medtronic Cobalt and Crome.

Cardiovascular implantable electronic devices have revolutionized the management of heart failure with reduced ejection fraction. New device generations tend to be launched every few years, with incremental improvements in performance and safety and with an expectation that these will improve patient management and outcomes while remaining cost-effective. As a result, today's cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillator devices are quite different from the pioneering but often bulky devices of the late 20th century. This review discusses new and improved features developed to target specific needs in managing heart failure patients, some of which are especially pertinent to the current worldwide healthcare situation, with focus on the latest generation of CRTs with defibrillator (CRT-Ds) and implantable cardioverter defibrillators from Medtronic.

Lay abstract Cardiac pacemaker devices, especially those that can retune the pumping function of the heart (known as resynchronization therapy) and those that provide shocks to restore a normal heart rhythm (known as implantable defibrillators) have revolutionized the management of heart failure over the last three decades and continue to improve in terms of their safety, effectiveness and battery life. This review discusses new and improved features developed to target specific needs in managing heart failure patients, specifically focusing on the latest generation of devices from Medtronic.

Multiparameter diagnostic sensor measurements in heart failure patients presenting with SARS-CoV-2 infection.

AIMS: Implantable device-based sensor measurements including heart sounds, markers of ventilation, and thoracic impedance have been shown to predict heart failure (HF) hospitalizations. We sought to assess how these parameters changed prior to COVID-19 (Cov-19) and how these compared with those presenting with decompensated HF or pneumonia. METHODS AND RESULTS: This retrospective analysis explores patterns of changes in daily measurements by implantable sensors in 10 patients with Cov-19 and compares these findings with those observed prior to HF (n = 88) and pneumonia (n = 12) hospitalizations from the MultiSENSE, PREEMPT-HF, and MANAGE-HF trials. The earliest sensor changes prior to Cov-19 were observed in respiratory rate (6 days) and temperature (5 days). There was a three-fold to four-fold greater increase in respiratory rate, rapid shallow breathing index, and night heart rate compared with those presenting with HF or pneumonia. Furthermore, activity levels fell more in those presenting with Cov-19, a change that was often sustained for some time. In contrast, there were no significant changes in 1st or 3rd heart sound (S1 and S3 ) amplitude in those presenting with Cov-19 or pneumonia compared with the known changes that occur in HF decompensation. CONCLUSIONS: Multi-sensor device diagnostics may provide early detection of Cov-19, distinguishable from worsening HF by an extreme and fast rise in respiratory rate along with no changes in S3.

Virtual multidisciplinary care for heart failure patients with cardiac resynchronization therapy devices during the Coronavirus Disease 2019 pandemic.

BACKGROUND: Heart failure (HF) patients with CRT devices are a vulnerable patient population during the Coronavirus Disease 2019 (COVID-19) Pandemic. It is important to develop innovative virtual care models to deliver multidisciplinary care while minimizing the risk of SARS-CoV2 exposure. OBJECTIVE: We aim to provide a description of how HF patients with CRT devices were assessed and managed in our virtual multidisciplinary clinic during the COVID-19 Pandemic. Clinical outcomes between this group of patients seen in virtual clinic and a historical cohort followed by in-person multi-disciplinary clinic prior to the pandemic were compared. METHOD: This is a retrospective cohort study of HF patients with CRT implants who were seen in the virtual multidisciplinary clinic from March 18th, 2020 to May 27th, 2020 (Virtual Visit Group, N = 43). A historical cohort of HF patients with CRT devices seen in the ReACT clinic in person during the same calendar time period in 2019 was used as a control group (In-Person Visit Group, N = 39). Both groups were followed until July 1st of the same calendar year (2020 or 2019) for clinical events. The primary outcome measure was a combined outcome of all-cause mortality and HF- or device-related hospitalizations during follow-up. The secondary outcome measures included patient satisfaction, COVID-19 infection, and other cardiovascular events. RESULTS: In the Virtual-Visit Group, 21 patients (48.8%) had their initial ReACT clinic visit (first visit after CRT implant) as a virtual visit; 22 patients (51.2%) had prior in-person ReACT clinic visits before the first virtual visit. During the virtual visits, 12 patients had either potential cardiac symptoms or significant device interrogation findings that required clinical intervention. In post-virtual clinic patient satisfaction survey, all 22 patients surveyed (100%) reported being very satisfied or satisfied with the overall experience of the virtual clinic, and every patient (100%) said they would like to use telemedicine again. During a median follow-up period of 82 days (interquartile range [IQR] 61-96 days), one patient died from pneumonia of unclear etiology at an outside hospital, without documentation of COVID-19 positivity. No patient was hospitalized for HF- or arrhythmia-related complications. No patient was diagnosed with COVID-19. Compared with the In-Person Visit Group, there was no significant increase in mortality or major cardiovascular events in the Virtual-Visit Group (2.3% versus 5.1%, P = 0.60). CONCLUSIONS AND RELEVANCE: Virtual multidisciplinary care was feasible for HF patients with cardiac resynchronization therapy devices and achieved good patient satisfaction. Virtual care was not associated with short-term increase in adverse events for HF patients with CRT device during the COVID-19 Pandemic. This virtual care model could help promote the adoption of digital health methodology for high-risk patients with multiple cardiac comorbidities.

Artificial intelligence in clinical care amidst COVID-19 pandemic: A systematic review.

The worldwide health crisis caused by the SARS-Cov-2 virus has resulted in>3 million deaths so far. Improving early screening, diagnosis and prognosis of the disease are critical steps in assisting healthcare professionals to save lives during this pandemic. Since WHO declared the COVID-19 outbreak as a pandemic, several studies have been conducted using Artificial Intelligence techniques to optimize these steps on clinical settings in terms of quality, accuracy and most importantly time. The objective of this study is to conduct a systematic literature review on published and preprint reports of Artificial Intelligence models developed and validated for screening, diagnosis and prognosis of the coronavirus disease 2019. We included 101 studies, published from January 1st, 2020 to December 30th, 2020, that developed AI prediction models which can be applied in the clinical setting. We identified in total 14 models for screening, 38 diagnostic models for detecting COVID-19 and 50 prognostic models for predicting ICU need, ventilator need, mortality risk, severity assessment or hospital length stay. Moreover, 43 studies were based on medical imaging and 58 studies on the use of clinical parameters, laboratory results or demographic features. Several heterogeneous predictors derived from multimodal data were identified. Analysis of these multimodal data, captured from various sources, in terms of prominence for each category of the included studies, was performed. Finally, Risk of Bias (RoB) analysis was also conducted to examine the applicability of the included studies in the clinical setting and assist healthcare providers, guideline developers, and policymakers.

Remote Monitoring of Respiratory Pattern in an ICD Patient With COVID-19 Pneumonia.

A 67-year-old man with history of heart failure developed dyspnea. In this report, we describe an increase in his device-detected respiratory rate. Monitoring respiratory rate is recommended for evaluating acute cardiac decompensation, but such an algorithm could also be used to diagnose episodes of pneumonia caused by severe acute respiratory syndrome-coronavirus-2 infection. (Level of Difficulty: Intermediate.).

Applications of the Multisensor HeartLogic Heart Failure Monitoring Algorithm During the COVID-19 Global Pandemic.

In the COVID-19 era, the heart failure community has witnessed an unprecedented reduction in heart failure-related patient visits and hospitalizations. Social distancing measures present a dilemma for patients with heart failure who require frequent surveillance of volume status and vital signs to minimize heart failure-related symptoms and hospitalizations. With the rise of telemedicine comes an increased focus on remote monitoring technologies. This report describes use of a multisensor device algorithm in implantable cardioverter defibrillator devices by Boston Scientific, called HeartLogic. We present 2 cases of patients with advanced heart failure who were actively surveilled by the HeartLogic device algorithm to guide care. (Level of Difficulty: Beginner.).

Cardiac electrophysiology consultative experience at the epicenter of the COVID-19 pandemic in the United States.

BACKGROUND: The COVID-19 pandemic has greatly altered the practice of cardiac electrophysiology around the world for the foreseeable future. Professional organizations have provided guidance for practitioners, but real-world examples of the consults and responsibilities cardiac electrophysiologists face during a surge of COVID-19 patients is lacking. METHODS: In this observational case series we report on 29 consecutive inpatient electrophysiology consultations at a major academic medical center in New York City, the epicenter of the pandemic in the United States, during a 2 week period from March 30-April 12, 2020, when 80% of hospital beds were occupied by COVID-19 patients, and the New York City metropolitan area accounted for 10% of COVID-19 cases worldwide. RESULTS: Reasons for consultation included: Atrial tachyarrhythmia (31%), cardiac implantable electronic device management (28%), bradycardia (14%), QTc prolongation (10%), ventricular arrhythmia (7%), post-transcatheter aortic valve replacement conduction abnormality (3.5%), ventricular pre-excitation (3.5%), and paroxysmal supraventricular tachycardia (3.5%). Twenty-four patients (86%) were positive for COVID-19 by nasopharyngeal swab. All elective procedures were canceled, and only one urgent device implantation was performed. Thirteen patients (45%) required in-person evaluation and the remainder were managed remotely. CONCLUSION: Our experience shows that the application of a massive alteration in workflow and personnel forced by the pandemic allowed our team to efficiently address the intersection of COVID-19 with a range of electrophysiology issues. This experience will prove useful as guidance for emerging hot spots or areas affected by future waves of the pandemic.