Leading Groups Develop Guidance for Arrhythmia Management in Current Climate

The Heart Rhythm Society, the American College of Cardiology Electrophysiology Council, and the American Heart Association Electrocardiography and Arrhythmias Committee have developed a joint document that provides guidance for cardiac electrophysiology (EP) during the coronavirus disease 2019 (COVID-19) pandemic. 

Included in the document is guidance on the management of invasive and noninvasive EP procedures, clinic visits, and cardiac device interrogations. The document also describes methods of triage based on acuity and patient comorbidities.

“Many patients with arrhythmias are among the sickest of those with cardiovascular disease. To protect patients (many of whom are [at] high risk due to coexisting comorbidities) and health care teams from COVID-19 exposure, preserve resources, and maintain access to necessary cardiovascular care, it is important that nonessential encounters, tests, and procedures be postponed,” according to the panel’s statement.

When feasible, clinic visits and in-person cardiac implantable electronic device checks should be converted to telehealth and remote checks. As these visits and clinics transition to being virtual, the panel highlights the need for a continued patient-provider relationship.

“While EP is uniquely suited to leverage virtual care and remote monitoring, it is important to assure patients that they have our full support, and we are ready and able to provide care as necessary,” according to the panel.

Information on resource conservation and training for all personnel, as well as on cardiopulmonary resuscitation, advanced cardiac life support, and arrhythmia management of patients with COVID-19 is also included.

The document comes as reports of associations between COVID-19 and cardiac complications arise.

“In a recent report from Wuhan, China, 16.7% of hospitalized and 44.4% of [intensive care unit] patients with COVID-19 had arrhythmias,” according to the panel. “In addition, there have been anecdotal reports of patients experiencing late myocardial dysfunction, as well as cardiopulmonary arrest with pulseless electrical activity or ventricular fibrillation during the recovery phase of their pulmonary illness.” 

—Colleen Murphy


Lakkireddy DR, Chung MK, Gopinathannair R, et al. Guidance for cardiac electrophysiology during the coronavirus (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 [published online April 1, 2020]. Heart Rhythm. doi:10.1016/j.hrthm.2020.03.028