Introduction: There is growing evidence that COVID-19 can cause cardiovascular complications. However, there are limited data on the characteristics and importance of atrial arrhythmia (AA) in patients hospitalized with COVID-19. Methods: Data from 1029 patients diagnosed with of COVID-19 and admitted to Columbia University Medical Center between March 1st and April 15th 2020 were analyzed. The diagnosis of AA was confirmed by 12 lead electrocardiographic recordings, 24-hour telemetry recordings and implantable device interrogations. Patients’ history, biomarkers and hospital course were reviewed. Outcomes of death, intubation and discharge were assessed. Results: Of 1029 patients, 82 (8%) were diagnosed with AA. Out of the 82 patients with AA. Of the AA patients, new-onset AA was seen in 46 (56%) patients, recurrent paroxysmal and chronic persistent were diagnosed in 16 (20%) and 20 (24%) individuals, respectively. Sixty-five percent of the patients diagnosed with AA (n=53) died. Patients diagnosed with AA had significantly higher mortality compared to those without AA (65% vs. 21%; p < 0.001). Predictors of mortality were older age (Odds Ratio (OR) =1.12, [95% Confidence Interval (CI), 1.04 to 1.22]); male gender (OR=6.4 [95% CI, 1.3 to 32]); azithromycin use (OR=13.4 [95% CI, 2.14 to 84]); and higher D-dimer levels (OR=2.8 [95% CI, 1.1 to7.3]). Conclusions: Patients diagnosed with AA had 3.1 times significant increase in mortality rate versus patients without diagnosis of AA in COVID-19 patients. Older age, male gender, azithromycin use and higher baseline D-dimer levels were predictors of mortality.
Introduction: Severely ill inpatients with SARS-CoV-2 infection, Coronavirus Disease 2019 (COVID-19) require close electrocardiographic (ECG) monitoring due to frequent cardiac involvement of the disease and cardiovascular side effects of therapies. This study aimed to compare ECG parameters measured from conventional 12-lead ECGs to those from a telemetry-generated 7-lead or single lead ECG to determine if the latter may be an alternative for screening and monitoring patients, particularly during a pandemic. Methods and Results: We identified 33 patients with respiratory failure due to COVID-19 undergoing telemetry monitoring in the intensive care unit. Each received a 12-lead ECG utilizing standard lead placement. A concurrent 7-lead ECG and single lead (lead II) tracing were obtained using the central telemetry system. Each ECG was interpreted and intervals manually measured by 2 cardiologists with disagreements adjudicated by a third. Compared to the 12-lead ECG measurement, the 7-lead ECG underestimated the corrected QT by on average 13.45±32.05 msec, and the single lead ECG underestimated corrected QT by 19.62±33.19 msec (Bazett, p < 0.05). Bland Altman analysis also demonstrated evidence of a positive bias, suggesting that the telemetry-derived tracings underestimated the QT interval. The presence of T wave abnormalities and ST segment changes were overestimated by the telemetry-derived tracings as compared to standard ECGs. Conclusion: Though telemetry-derived ECGs may be useful in screening patients for significant ECG abnormalities, they likely do not represent a reliable replacement of the standard 12-lead ECG in the routine diagnosis and management of critically ill patients.
A global coronavirus (COVID-19) pandemic occurred at the start of 2020 and is already responsible for more than 74,000 deaths worldwide, just over 100 years after the influenza pandemic of 1918. At the center of the crisis is the highly infectious and deadly SARS-CoV-2, which has altered everything from individual daily lives to the global economy and our collective consciousness. Aside from the pulmonary manifestations of disease, there are likely to be several electrophysiologic (EP) sequelae of COVID-19 infection and its treatment, due to consequences of myocarditis and the use of QT-prolonging drugs. Most crucially, the surge in COVID-19 positive patients that have already overwhelmed the New York City hospital system requires conservation of hospital resources including personal protective equipment (PPE), reassignment of personnel, and reorganization of institutions, including the EP laboratory. In this proposal, we detail the specific protocol changes that our EP department has adopted during the COVID-19 pandemic, including performance of only urgent/emergent procedures, afterhours/7-day per week laboratory operation, single attending-only cases to preserve PPE, appropriate use of PPE, telemedicine and video chat follow-up appointments, and daily conferences to collectively manage the clinical and ethical dilemmas to come. We discuss also discuss how we perform EP procedures on presumed COVID positive and COVID tested positive patients in order to highlight issues that others in the EP community may soon face in their own institution as the virus continues to spread nationally and internationally.