Background Restrictions as a result of the COVID-19 pandemic have demanded an innovative approach to provide appropriate patient review. We have been running virtual cardiology clinics as per Health Service Executive guidance. Aims Our study aims to determine how virtual clinics change practice vs traditional clinics. Methods A retrospective cohort analysis was conducted on patients attending cardiology clinics in our hospital from 6 January to 13 March 2020 (‘traditional clinic’, n = 1644), compared with clinics during the COVID-19 outbreak, from 16 March to 22 April 2020 (‘virtual clinic’, n = 691), with the same medical staff. Results There was no difference in age (61 vs 60), case mix or new vs return appointments in virtual vs traditional clinics. There were similar rates of clinic participation, 71.8% vs 74.2%. A lower proportion of investigations (e.g. imaging) were booked in virtual (38.5%) vs traditional (55.7%) clinics, p < 0.00001. Management changes (e.g. medication changes) were less frequent in virtual (19.9%) vs traditional (38.5%) clinics, p < 0.00001. However, the discharge rate was higher in virtual (28.8%) vs traditional (19.5%) clinics, p = 0.00003. Conclusion This study highlights that virtual clinic consultations are associated with fewer investigations, fewer management changes, and increased discharge rates compared with traditional consultations. These practice changes would reduce costs and hospital outpatient congestion by avoiding unnecessary hospital reviews. Nonetheless, it is unknown whether patients requiring face-to-face consultations could be missed as a result of this virtual approach. Longitudinal studies are required to assess clinical outcomes as a result of these practice changes and whether patient satisfaction is altered. Supplementary Information The online version contains supplementary material available at 10.1007/s11845-021-02617-z.

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Cardiac electrophysiology is an evolving specialty that has seen rapid advances in recent years. Concurrently, there has been much progress in the field of cardiac imaging. Electrophysiologists are increasingly requesting cross-sectional imaging in advance of many procedures. Pulmonary vein isolation and left atrial appendage (LAA) occlusion are now an established treatment options for atrial fibrillation. In patients undergoing pulmonary vein isolation, applications of computed tomography (CT) include evaluating the left atrial and pulmonary venous anatomy, excluding LAA thrombus and assessing for pulmonary vein stenosis. In those undergoing LAA occlusion, CT may be of value in assessing the size, position, and morphology of the LAA as well as for determining correct positioning of the device and evaluating for peri-device leak. Implantable cardiac devices are now commonly used in the management of cardiac failure and cardiac arrhythmias. Applications of CT prior to device implantation include detecting myocardial scar, evaluating for mechanical dyssynchrony as well as visualising the coronary venous anatomy.

-The National Institute for Health and Clinical Excellence (NICE) guidelines for the management of atrial fibrillation were published in June 2006. It was anticipated that they would potentially lead to increased demand for echocardiography (ECHO), increased access to secondary care services (for example for cardioversion), and require additional resources for monitoring anticoagulation. A primary care survey was therefore initiated in South Devon, in advance of publication of the guidelines as a snapshot of existing practice, to determine any additional resources and education required to meet the new standards. The main aim was to determine what proportion of patients were managed exclusively in primary care, how frequently patients were investigated by ECHO and whether anticoagulation was being appropriately targeted at patients at high risk of thromboembolic events.

A 39-year-old man with no significant past medical history and no conventional coronary risk factors presented with a history of gradually progressive exertional dyspnea and a systolic heart murmur. Chest x-ray showed an enlarged cardiac silhouette with pulmonary plethora. Initial assessment by transthoracic echocardiography demonstrated mild mitral regurgitation but also revealed an enlarged coronary sinus with abnormal Doppler flow patterns in the right atrium. A subsequent transesophageal echocardiogram demonstrated a large, serpiginous coronary artery fistula from the dominant left circumflex artery to the coronary sinus causing aneurysmal dilatation of the left circumflex artery extending back to the left main stem (maximum crosssectional diameter, 17 mm). No other congenital heart defects were identified. A 64-slice multidetector computed tomography (GE Lightspeed VCT, Chalfront St Giles, Buckinghamshire, UK) coronary angiogram confirmed the transesophageal echocardiographic findings and demonstrated that the left anterior descending and nondominant right coronary arteries were both unobstructed with no significant atherosclerotic disease. A treadmill exercise ECG stress test did not provoke any chest pain or ischemic ECG changes to stage 4 of the standard Bruce protocol. Cardiac magnetic resonance imaging revealed that the main pulmonary artery was dilated at 3.7 cm maximum dimension (aorta measured 3.2 in the same plane) with an estimated flow through the fistula of Ϸ2.7 L/min causing a high output state with subsequent dilatation of both right and left ventricles (right ventricular end-diastolic volume, 290 mL; left ventricular end-diastolic volume, 330 mL).