Restructuring Electrophysiology During the COVID-19 Pandemic: A Practical Guide From a New York City Hospital Network

Rubin, Geoffrey; Wan, Elaine; Saluja, Deepak; Thomas, George; Slotwiner, David J.; Goldbarg, Seth; Chaudhary, Salma; Turitto, Gioia; Dizon, José; Yarmohammadi, Hirad; Ehlert, Frederick; Rubin, David A.; Morrow, John; Waase, Marc; Berman, Jeremy; Kushnir, Alexander; Abrams, Mark P.; Halik, Carolyn; Kumaraiah, Deepa; Schwartz, Allan; Kirtane, Ajay J.; Kodali, Susheel; Goldenthal, Isaac; Garan, Hasan; Biviano, Angelo

doi:10.1097/hpc.0000000000000225

Cited by 14 publications

(13 citation statements)

References 7 publications

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“…During the current COVID-19 pandemic, several publications are providing guidance for clinicians and institutions to rebuild safe electrophysiological care [13][14][15]. A joint guidance from the Heart Rhythm Society, the American Heart Association, and a committee within the American College of Cardiology recommends consideration of same-day discharge, as clinically appropriate, to minimize patient exposure [13].…”

Section: Discussionmentioning

confidence: 99%

Prospective implementation of a same-day discharge protocol for catheter ablation of paroxysmal atrial fibrillation

Rajendra

Hunter

Morales

et al. 2020

J Interv Card Electrophysiol

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Purpose Overnight stays associated with catheter ablation (CA) for paroxysmal atrial fibrillation (PAF) account for a significant proportion of treatment cost. Same-day discharge (SDD) after CA may be attractive to both patients and hospitals, especially in light of current restrictions on overnight stays due to COVID-19. This study reports on the selection criteria, protocol, and safety of SDD after CA of PAF. Methods Patients undergoing CA for PAF were evaluated to assess the risk of groin, respiratory, cardiac, or bleeding complications. SDD eligibility criteria were stable anticoagulation with no bleeding history, systolic heart failure, respiratory conditions, or interventional procedures within 60 days, and recommended BMI < 35. Patient proximity to the hospital was also considered. Anesthesia with propofol was used, and ablations were performed with a contact force catheter. Patients rested for 6 h postprocedure and then ambulated over 1-2 h. Discharge followed if they were stable without evidence of complications. A nurse called all patients the following morning to elicit evidence of complications. Results Of 44 planned SDD procedures between April 2017 and June 2018, 41 resulted in SDD after 7.2 ± 1.0 h, 2 patients stayed overnight for observation, and one by choice. Average age was 59 ± 10 years with CHA 2 DS 2-VASc of 1.6 ± 1.1. No SDD-related complications occurred, and no return visits resulted from the follow-up calls. Conclusion Appropriate low-risk patients identified by well-defined clinical criteria can be safely discharged the same day after CA for PAF. Evaluation in a larger population across different centers is required for generalizability of this SDD protocol.

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Section: Discussionmentioning

confidence: 99%

Prospective implementation of a same-day discharge protocol for catheter ablation of paroxysmal atrial fibrillation

Rajendra

Hunter

Morales

et al. 2020

J Interv Card Electrophysiol

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“…The fundamental goal is to avoid elective procedures in order to conserve precious resources like PPE and hospital beds and also minimize unnecessary exposure to COVID-19. A practical guide from a New York City Hospital Network describes an approach used to overcome these challenges due to the surge of COVID-19 activity in New York by ramping down and restructuring of the electrophysiology services ( 74 ).…”

Section: Channelopathies and Inherited Arrhythmia Syndromementioning

confidence: 99%

“…In locations with limited testing availability or with concern for community spread, it may be prudent to consider at least droplet precautions for all electrophysiology procedures. N95 masks should be used by all operating physicians and a surgical mask for all patients ( 74 ). If needing intubation which is an aerosol generating procedure, it is recommended to consider performing in a negative pressure room either in the electrophysiology lab or inpatient ICU before bringing the patient to electrophysiology lab.…”

Section: Channelopathies and Inherited Arrhythmia Syndromementioning

confidence: 99%

“…Anesthesia data recommends to limit personnel in the procedure room during intubation or extubation and to follow institutional protocols for the length of time before other personnel can return to the room after intubation which could be between 15 and 30 min based on frequency of air exchanges and the type of PPE used ( 76 ). Conscious sedation can be considered by EP attending with backup anesthesia services without compromising patient safety ( 74 ). Electrocautery is another aerosol generating procedure that is routinely used during device implantation procedures, and the smoke produced can have a significant amount of viral load.…”

Section: Channelopathies and Inherited Arrhythmia Syndromementioning

confidence: 99%

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Arrhythmias and COVID-19

Dherange

Lang

Qian

et al. 2020

JACC: Clinical Electrophysiology

151

156

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Current understanding of the impact of coronavirus disease-2019 (COVID-19) on arrhythmias continues to evolve as new data emerge. Cardiac arrhythmias are more common in critically ill COVID-19 patients. The potential mechanisms that could result in arrhythmogenesis among COVID-19 patients include hypoxia caused by direct viral tissue involvement of lungs, myocarditis, abnormal host immune response, myocardial ischemia, myocardial strain, electrolyte derangements, intravascular volume imbalances, and drug sides effects. To manage these arrhythmias, it is imperative to increase the awareness of potential drug-drug interactions, to monitor QTc prolongation while receiving COVID therapy and provide special considerations for patients with inherited arrhythmia syndromes. It is also crucial to minimize exposure to COVID-19 infection by stratifying the need for intervention and using telemedicine. As COVID-19 infection continues to prevail with a potential for future surges, more data are required to better understand pathophysiology and to validate management strategies.

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“…Hospital operations have been significantly altered resulting from the COVID-19 crisis, as previously documented. 35 To F I G U R E Paired comparison of QT Intervals in patients receiving hydroxychloroquine, azithromycin, and both. This paired comparison demonstrates no significant differences in QT, QTc, or QTf intervals between admission and the last electrocardiogram before death in patients receiving hydroxychloroquine, azithromycin, and both.…”

Section: Study Limitationsmentioning

confidence: 99%

Clinical and cardiac characteristics of COVID‐19 mortalities in a diverse New York City Cohort

Abrams

Wan

Waase

et al. 2020

Cardiovasc electrophysiol

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Introduction Electrocardiographic characteristics in COVID‐19‐related mortality have not yet been reported, particularly in racial/ethnic minorities. Methods and Results We reviewed demographics, laboratory and cardiac tests, medications, and cardiac rhythm proximate to death or initiation of comfort care for patients hospitalized with a positive SARS‐CoV‐2 reverse‐transcriptase polymerase chain reaction in three New York City hospitals between March 1 and April 3, 2020 who died. We described clinical characteristics and compared factors contributing toward arrhythmic versus nonarrhythmic death. Of 1258 patients screened, 133 died and were enrolled. Of these, 55.6% (74/133) were male, 69.9% (93/133) were racial/ethnic minorities, and 88.0% (117/133) had cardiovascular disease. The last cardiac rhythm recorded was VT or fibrillation in 5.3% (7/133), pulseless electrical activity in 7.5% (10/133), unspecified bradycardia in 0.8% (1/133), and asystole in 26.3% (35/133). Most 74.4% (99/133) died receiving comfort measures only. The most common abnormalities on admission electrocardiogram included abnormal QRS axis (25.8%), atrial fibrillation/flutter (14.3%), atrial ectopy (12.0%), and right bundle branch block (11.9%). During hospitalization, an additional 17.6% developed atrial ectopy, 14.7% ventricular ectopy, 10.1% atrial fibrillation/flutter, and 7.8% a right ventricular abnormality. Arrhythmic death was confirmed or suspected in 8.3% (11/133) associated with age, coronary artery disease, asthma, vasopressor use, longer admission corrected QT interval, and left bundle branch block (LBBB). Conclusions Conduction, rhythm, and electrocardiographic abnormalities were common during COVID‐19‐related hospitalization. Arrhythmic death was associated with age, coronary artery disease, asthma, longer admission corrected QT interval, LBBB, ventricular ectopy, and usage of vasopressors. Most died receiving comfort measures.

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Restructuring Electrophysiology During the COVID-19 Pandemic: A Practical Guide From a New York City Hospital Network

Cited by 14 publications

References 7 publications

Prospective implementation of a same-day discharge protocol for catheter ablation of paroxysmal atrial fibrillation

Prospective implementation of a same-day discharge protocol for catheter ablation of paroxysmal atrial fibrillation

Arrhythmias and COVID-19

Clinical and cardiac characteristics of COVID‐19 mortalities in a diverse New York City Cohort

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