Guidance for cardiac electrophysiology during the COVID-19 pandemic from the Heart Rhythm Society COVID-19 Task Force; Electrophysiology Section of the American College of Cardiology; and the Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, American Heart Association

Abstract

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.

Keywords: COVID-19; Electrophysiology; Health planning guidelines; Pandemics; Pathology; Practice guideline; Virus.

Figure 1

Guidance on EP procedures for urgent, semiurgent, or nonurgent procedures in the hospital setting. See text for details. AF = atrial fibrillation; AFL = atrial flutter; AV = atrioventricular; AVB = atrioventricular block; CHB = complete heart block; CIED = cardiac implantable electronic device; COVID-19 = coronavirus disease 2019; CRT = cardiac resynchronization therapy; ED = emergency department; EOS = end of service; EP = electrophysiology; ERI = elective replacement indicator; HF = heart failure; ICD = implantable cardioverter defibrillator; ICU = intensive care unit; LAA = left atrial appendage; LBBB = left bundle-branch block; PAPR = powered air-purifying respirator; PM = permanent pacemaker; PPE = personal protective equipment; PUI = patient under investigation for COVID-19; PVC = premature ventricular contraction; RVR = rapid ventricular rate; SND = sinus node dysfunction; SVT = supraventricular tachycardia; TEE = transesophageal echocardiography; VT = ventricular tachycardia; WPW = Wolff-Parkinson-White.

Figure 2

Guidance on nonprocedural care in outpatient clinic visits and CIED monitoring in the outpatient and inpatient settings. CDC = Centers for Disease Control and Prevention; CIED = cardiac implantable electrical device; COVID-19 = coronavirus disease 2019; ED = emergency department; ICD = implantable cardioverter defibrillator; PAPR = powered air-purifying respirator; PPE = personal protective equipment; PUI = patient under investigation for COVID-19.

Figure 3

Role of an electrophysiologist in being an important solution in managing a pandemic such as COVID-19. One has responsibility to self, family, patients, other healthcare professionals and to be a good steward for resource conservation. COVID-19 = coronavirus disease 2019; PPE = personal protective equipment.