Arrhythmias and sudden cardiac death in the COVID-19 pandemic

Coronavirus disease 2019 (COVID-19) is a global pandemic with almost 2 million infections confirmed worldwide and close to 120,000 deaths; the estimated mortality rate ranges from continent to continent between 3 and 9% (as of April 15, 2020) Incidence of arrhythmias COVID-19 causes myocardial injury, with at least 17% of cases found to have an elevated troponin level and 23% noted to have heart failure in a study of 191 inpatients from Wuhan, China. Cases of fulminant myocarditis with cardiogenic shock have also been reported, with associated atrial and ventricular arrhythmias. Electrophysiologists play an important role in cardiovascular health, with more than 40% of symptoms in cardiology being arrhythmia-related. Besides myocardial infarction and heart failure, arrhythmias are generally one of the three major risks associated with viral infections, due to myocarditis, proinflammatory effects, and an increased sympathetic stimulation. In a report from Wuhan, China, 16.7% of hospitalized and 44.4% of intensive care unit (ICU) patients with COVID-19 had arrhythmias Given that hypoxia and electrolyte abnormalities that are common in the acute phase of severe illness can potentiate cardiac arrhythmias, the exact arrhythmic risk related to COVID-19 in patients with less severe illness or those who recover from the acute phase of the severe illness is currently unknown. Improved understanding of this is critical, primarily in guiding decisions on whether additional arrhythmia monitoring is needed (e.g., mobile cardiac telemetry) after discharge and whether an implantable cardioverter defibrillator (ICD) or wearable cardioverter defibrillator will be needed in those with impaired left ventricular function thought to be secondary to COVID-19. General recommendations for electrophysiologists Finally, the number of individuals in hospital rounding should be minimized and social distancing should be practiced. For patients with suspected or confirmed COVID-19 infection, the staff and the time spent in the room should also be limited. Many electrophysiology (EP) consultations may be completed without a face-to-face visit, by reviewing the chart and monitoring data. Non-urgent or non-emergent procedures should be postponed to a later date. Clinic visits and in-person cardiac implantable electronic device checks should be changed to tele-health and remote checks whenever feasible. To read more- https://link.springer.com/article/10.1007/s00059-020-04924-0

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Arrythmia can be tried with intravenous Calcium gluconate every fourth hourly one ampoule slow i.v for three days with blood calcium levels monitiring
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