Introduction
In December 2019, a highly infectious novel coronavirus (COVID-19) outbreak was reported in Wuhan, China1. Less than 3 months later, we are now amidst a global COVID-19 pandemic which has disrupted the international economic order and significantly altered activities of daily living and personal interactions for nearly everyone on earth, due to requisite social distancing, “shelter-at-home” and lockdown orders instituted in many locations.
In New York state, as of April 6, 2020 there are over 130,000 confirmed COVID-19 cases, the most in the United States. The vast majority of COVID-19 diagnoses have been made within the densely populated New York City, which itself has 72,000 confirmed cases and is now considered a COVID-19 epicenter. At NewYork-Presbyterian Hospital (NYPH), the case rate is nearly doubling every day, which mirrors the overall state trend. Personal protective equipment (PPE), as has been reportedly nationally, is at a critical shortage.
The coronavirus principally causes pulmonary manifestations of fever, cough and dyspnea with occasional rapid progression to severe respiratory failure and acute respiratory distress syndrome (ARDS) in both high-risk and healthy patient populations. Yet between 7.2-12% of total COVID-19 patients manifest cardiac injury and progression to fulminant myocarditis was recently described2-4.
Importantly, there are likely to be several electrophysiologic (EP) sequelae of COVID-19 infection. Wang et al. describe arrhythmia burden of 16.7% in 138 total COVID-19 patients and 44.4% of COVID-19 ICU patients2. As yet, it is unknown whether the virus directly seeds the cardiac conduction system. Electrophysiologists will play an important role in the upcoming months, especially since COVID-19 treatments such as hydroxychloroquine carry known deleterious electrophysiological effects5. EPs may see more cases of drug-induced torsades in the near future. There have also been recent reported cases of ventricular arrhythmias due to COVID myocarditis.6
It was therefore important to institute specific EP laboratory protocols not only to treat the inevitable COVID-19-infected patient requiring any urgent or emergent procedures, but also so that we may continue to treat sick, non-COVID infected patients with a high quality standard of care. Management operations are in flux during this crisis and may even change from day-to-day. We present our overarching workflow model to optimize laboratory function with the aim of both adequately protecting providers, successfully treating patients and conserving PPE during this unprecedented period. This has been an urgent collaborative formulation by the Columbia University Electrophysiology subdivision at Columbia University Medical Center, and is not a reflection of official NYPH policy. We present this as a model for other EP labs in the nation who are facing or soon may be faced with this healthcare challenge.