key: cord-1051962-2brgdh2g
authors: Khan, Ahmed N.; Desai, Karan; Zviman, Adam; Hong, Susie N.; Ananthram, Manjula; Liu, Stanley; Srivastava, Mukta C.; Benitez, Michael; Hong, Charles C.; Dickfeld, Timm M.; Jimenez Restrepo, Alejandro
title: Balancing Service and Safety: Cardiovascular Medicine Divisional Response to the COVID-19 Pandemic
date: 2020-07-15
journal: JACC Case Rep
DOI: 10.1016/j.jaccas.2020.05.058
sha: 9408ffe8e1dfc9d6d721a537ff78336e9724a98f
doc_id: 1051962
cord_uid: 2brgdh2g

[Figure: see text]

Our service is modeled after previously published "e-consultation" workflow recommendations in "peacetime" prior to the SARS-CoV-2 outbreak (4). Our approach to STAT and routine TEE is outlined in Remote monitoring is used for electrophysiology clinic device checks, with patients triaged to present for evaluation if they develop concerning arrhythmias, heart failure alerts, or device-related issues. *VT storm that has failed medical treatment including at least 2 antiarrhythmic drugs (including propranolol), treatment of underlying reversible condition if present (QTc prolongation due to ischemia, medications, or metabolic/electrolyte imbalance), general anesthesia, and left stellate ganglion block (if available). †Not reversible or fails to respond to chronotropic drugs such as isoproterenol, dopamine, and/or scopolamine, and temporary pacing cannot be safely maintained in an intensive care setting. In this scenario a screw-in active fixation lead connected to an externalized generator or an active fixation temporary pacing lead may be considered depending on the patient's clinical condition and could be performed in the intensive care setting under fluoroscopic guidance (if available) or in an operating room with negative airflow capabilities and fluoroscopy.

CIED ¼ cardiac implantable electronic devices; EOS ¼ end of service; ERI ¼ elective replacement indicator; VT ¼ ventricular tachycardia. Figures 1 and 3 . 

Prevalence of comorbidities in the Middle East respiratory syndrome coronavirus (MERS-CoV): a systematic review and meta-analysis

Acute myocardial infarction after laboratoryconfirmed influenza infection

Clinical characteristics of coronavirus disease 2019 in China

Integrating inpatient electronic consultations in cardiology fellowship

Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China

COVID-19 and the cardiovascular system

Catheterization laboratory considerations during the Coronavirus (COVID-19) Pandemic: from ACC's Interventional Council and SCAI

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

Guidance for Cardiothoracic Transplant and Mechanical Circulatory Support Centers regarding SARS CoV-2 infection and COVID-19