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

• Published in: Indian pacing and electrophysiology journal 2020-11, Vol.20 (6), p.250-256
• Main Authors: Berman, Jeremy P., Abrams, Mark P., Kushnir, Alexander, Rubin, Geoffrey A., Ehlert, Frederick, Biviano, Angelo, Morrow, John P., Dizon, Jose, Wan, Elaine Y., Yarmohammadi, Hirad, Waase, Marc P., Rubin, David A., Garan, Hasan, Saluja, Deepak
• Format: Article
• Language: English
• Subjects: Arrhythmia; Coronavirus; COVID-19; Electrophysiology; Original
• ISSN: 0972-6292; 0972-6292
• DOI: 10.1016/j.ipej.2020.08.006

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. 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. 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. 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.