Background COVID‐19 was temporally associated with an increase in out‐of‐hospital cardiac arrests, but the underlying mechanisms are unclear. We sought to determine if patients with implantable defibrillators residing in areas with high COVID‐19 activity experienced an increase in defibrillator shocks during the COVID‐19 outbreak. Methods and Results Using the Medtronic (Mounds View, MN) Carelink database from 2019 and 2020, we retrospectively determined the incidence of implantable defibrillator shock episodes among patients residing in New York City, New Orleans, LA, and Boston, MA. A total of 14 665 patients with a Medtronic implantable defibrillator (age, 66±13 years; and 72% men) were included in the analysis. Comparing analysis time periods coinciding with the COVID‐19 outbreak in 2020 with the same periods in 2019, we observed a larger mean rate of defibrillator shock episodes per 1000 patients in New York City (17.8 versus 11.7, respectively), New Orleans (26.4 versus 13.5, respectively), and Boston (30.9 versus 20.6, respectively) during the COVID‐19 surge. Age‐ and sex‐adjusted hurdle model showed that the Poisson distribution rate of defibrillator shocks for patients with ≥1 shock was 3.11 times larger (95% CI, 1.08–8.99; P =0.036) in New York City, 3.74 times larger (95% CI, 0.88–15.89; P =0.074) in New Orleans, and 1.97 times larger (95% CI, 0.69–5.61; P =0.202) in Boston in 2020 versus 2019. However, the binomial odds of any given patient having a shock episode was not different in 2020 versus 2019. Conclusions Defibrillator shock episodes increased during the higher COVID‐19 activity in New York City, New Orleans, and Boston. These observations may provide insights into COVID‐19–related increase in cardiac arrests.

The search for a load-independent index of myocardial contractility has been a focus for nearly 100 years. Nearly all of the parameters developed have yielded insight into cardiac function but their clinical utility has been limited. A new index, dsigma*/dt (max), has been proposed to be useful in the clinic. This parameter is expressed as the maximum time rate of change of the pressure normalized circumferential wall stress (sigma* = sigma ( theta )/P, where sigma ( theta ) is circumferential wall stress and P is pressure) for a thick walled sphere model of the left ventricle (LV). This definition for a contractility index renders dsigma*/dt (max) dependent only on LV wall volume (V (m)) and maximum time rate of change of the ventricular volume, dV/dt (max). The index dsigma*/dt (max) has been studied in patients with echocardiogram-derived volume, but up until this point its characteristics in canines have remained unknown. Validating this index in the canine will allow for a more intensive and wide-range investigation of the index that is not available with humans. The purpose of this study was to validate dsigma*/dt (max) as a load-independent measure of contractility in the canine heart with the hope that it was a noninvasive assessment of contractile function. To assess the load independence of dsigma*/dt (max), the index was estimated over a range of preloads (end diastolic volume, EDV) during a vena caval occlusion (VCO). The study was conducted in five canines under various pacing modes [right atrial (RA), right ventricular (RV), left ventricular (LV), and biventricular (BV)] at rates of 90 or 100, and 160 bpm. The animals' ventricular volume measurements were assessed by conductance catheter, calibrated with echocardiography. A 50 Hz filter was applied to the volume signal before differentiation to obtain dV/dt (max). Echocardiography was used to calculate left ventricle mass and V (m). In eight of ten cases, dsigma*/dt (max) was significantly correlated with decreasing EDV (p < 0.05). There was also a significant correlation between dsigma*/dt (max) and dP/dt (max). With a strong correlation between the values of dsigma*/dt (max), dP/dt (max), and EDV in all five subjects, dsigma*/dt (max) is not load independent in the canine heart when preload is altered by a VCO. Further evaluation of this index is required to delineate the situations where dsigma*/dt (max) can be accurately applied.

Intracellular regulation of myocardial Ca2+ has long been of interest to physiologists. The force-interval relationship provides a phenomenological approach that permits insight into aspects of calcium regulation. The response to an extrasystole is a potentiation in contractile force and the recovery in contractile force is described by the recirculation fraction (RF). The RF provides a gross estimation of calcium uptake by sarcoplasmic reticulum (SR), leading to myocardial relaxation. The current study focused on the relationship of right (RV) and left ventricular (LV) RF in canines under several contractile states. Anesthetized canines (n = 5) were catheterized for RV and LV pressure measurements. dP/dt(max) for the RV and LV was calculated for three baseline beats, one extrasystole and the first five postextrasystolic beats. The relationship between the LV dP/dt(max) and RV dP/dt(max) for all of the mentioned beats was then examined. Contractility was increased with calcium chloride and extrasystoles were delivered. Once cardiac function returned to a baseline level, contractility was reduced by increasing the concentration of isoflurane and the evaluation repeated. All ventricular contractions were controlled by RA pacing to maintain intrinsic conduction. A strong linear relationship between RV and LV dP/dt(max) (r = 0.94 +/- .06) existed for most canine's contractile states. These results build on findings in isolated hearts and demonstrate that biventricular response to extrasystoles and subsequent contractile recovery is both linear and correlated, suggesting that intracellular calcium regulation in a given heart across contractile state is static.

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