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      Guidance for Rebooting Electrophysiology Through the COVID-19 Pandemic From the Heart Rhythm Society and the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology

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      Author(s): , MD, FHRS 1 , , , MD, FHRS 2 , , MD, MBA, FHRS 3 , , MD, MA, FHRS 1 , , MD, MPH, FHRS 4 , , MD 5 , , MD, PhD 6 , , MD, FHRS 7 , , MSN, APRN-C 1 , , MD, FHRS 8 , , MD, FHRS 9 , , MD, FHRS 10 , , MD, FHRS 11 , , MD, FHRS 12 , , MD, FHRS 13 , , ANP, FHRS 14 , , MBBS, FHRS 15 , , MD, FHRS 16 , , MD, FHRS 17
      Publication date (Electronic):
      Journal: Circulation. Arrhythmia and Electrophysiology
      Publisher: Lippincott Williams & Wilkins
      Keywords: arrhythmia, COVID-19, electrophysiology, pandemic, return to work

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          Abstract

          Coronavirus disease 2019 (COVID-19) has presented substantial challenges to patient care and impacted healthcare delivery, including cardiac electrophysiology practice throughout the globe. Based upon the undetermined course and regional variability of the pandemic, there is uncertainty as to how and when to resume and deliver electrophysiology services for patients with arrhythmia. This joint document from representatives of the Heart Rhythm Society, American Heart Association, and American College of Cardiology seeks to provide guidance for clinicians and institutions reestablishing safe electrophysiological care. To achieve this aim, we address regional and local COVID-19 disease status, the role of viral screening and serological testing, return-to-work considerations for exposed or infected health care workers, risk stratification and management strategies based on COVID-19 disease burden, institutional preparedness for resumption of elective procedures, patient preparation and communication, prioritization of procedures, and development of outpatient and periprocedural care pathways.

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          Virological assessment of hospitalized patients with COVID-2019

          Roman Wölfel, Victor M Corman, Wolfgang Guggemos … (2020)
          Coronavirus disease 2019 (COVID-19) is an acute infection of the respiratory tract that emerged in late 20191,2. Initial outbreaks in China involved 13.8% of cases with severe courses, and 6.1% of cases with critical courses3. This severe presentation may result from the virus using a virus receptor that is expressed predominantly in the lung2,4; the same receptor tropism is thought to have determined the pathogenicity-but also aided in the control-of severe acute respiratory syndrome (SARS) in 20035. However, there are reports of cases of COVID-19 in which the patient shows mild upper respiratory tract symptoms, which suggests the potential for pre- or oligosymptomatic transmission6-8. There is an urgent need for information on virus replication, immunity and infectivity in specific sites of the body. Here we report a detailed virological analysis of nine cases of COVID-19 that provides proof of active virus replication in tissues of the upper respiratory tract. Pharyngeal virus shedding was very high during the first week of symptoms, with a peak at 7.11 × 108 RNA copies per throat swab on day 4. Infectious virus was readily isolated from samples derived from the throat or lung, but not from stool samples-in spite of high concentrations of virus RNA. Blood and urine samples never yielded virus. Active replication in the throat was confirmed by the presence of viral replicative RNA intermediates in the throat samples. We consistently detected sequence-distinct virus populations in throat and lung samples from one patient, proving independent replication. The shedding of viral RNA from sputum outlasted the end of symptoms. Seroconversion occurred after 7 days in 50% of patients (and by day 14 in all patients), but was not followed by a rapid decline in viral load. COVID-19 can present as a mild illness of the upper respiratory tract. The confirmation of active virus replication in the upper respiratory tract has implications for the containment of COVID-19.
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            Temporal dynamics in viral shedding and transmissibility of COVID-19

            Xi. He, Eric Lau, Peng Wu … (2020)
            We report temporal patterns of viral shedding in 94 patients with laboratory-confirmed COVID-19 and modeled COVID-19 infectiousness profiles from a separate sample of 77 infector-infectee transmission pairs. We observed the highest viral load in throat swabs at the time of symptom onset, and inferred that infectiousness peaked on or before symptom onset. We estimated that 44% (95% confidence interval, 25-69%) of secondary cases were infected during the index cases' presymptomatic stage, in settings with substantial household clustering, active case finding and quarantine outside the home. Disease control measures should be adjusted to account for probable substantial presymptomatic transmission.
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              Is Open Access

              Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2)

              Ruiyun Li, Sen Pei, Bin Chen … (2020)
              Estimation of the prevalence and contagiousness of undocumented novel coronavirus (SARS-CoV2) infections is critical for understanding the overall prevalence and pandemic potential of this disease. Here we use observations of reported infection within China, in conjunction with mobility data, a networked dynamic metapopulation model and Bayesian inference, to infer critical epidemiological characteristics associated with SARS-CoV2, including the fraction of undocumented infections and their contagiousness. We estimate 86% of all infections were undocumented (95% CI: [82%–90%]) prior to 23 January 2020 travel restrictions. Per person, the transmission rate of undocumented infections was 55% of documented infections ([46%–62%]), yet, due to their greater numbers, undocumented infections were the infection source for 79% of documented cases. These findings explain the rapid geographic spread of SARS-CoV2 and indicate containment of this virus will be particularly challenging.
              Article 0 comments Cited 1627 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Circ Arrhythm Electrophysiol
                Journal ID (iso-abbrev): Circ Arrhythm Electrophysiol
                Journal ID (publisher-id): HAE
                Title: Circulation. Arrhythmia and Electrophysiology
                Publisher: Lippincott Williams & Wilkins (Hagerstown, MD )
                ISSN (Print): 1941-3149
                ISSN (Electronic): 1941-3084
                Publication date (Electronic): 12 June 2020
                Publication date Collection: July 2020
                Volume: 13
                Issue: 7
                Electronic Location Identifier: e008999
                Affiliations
                [1 ]Kansas City Heart Rhythm Institute and Research Foundation, Overland Park (D.R.L., R.G., C.C.J.).
                [2 ]Heart, Vascular, and Thoracic Institute and Lerner Research Institute, Cleveland Clinic, OH (M.K.C.).
                [3 ]Piedmont Heart Institute, Atlanta, GA (T.F.D.).
                [4 ]Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.M.A.).
                [5 ]Northwell Health, Manhasset, New York (L.M.E.).
                [6 ]Case Western Reserve University, Cleveland, OH (C.V.H.).
                [7 ]North Texas Heart Center, Dallas (J.L.H.).
                [8 ]University of British Columbia, Vancouver, Canada (A.D.K.).
                [9 ]Mayo Clinic Jacksonville, FL (F.M.K.).
                [10 ]Yale School of Medicine, New Haven, CT (R.L.).
                [11 ]Massachusetts General Hospital, Boston (M.M.).
                [12 ]Texas Cardiac Arrhythmia Institute, Austin (A.N.).
                [13 ]University of Washington, Seattle (K.K.P.).
                [14 ]Cone Health, Greensboro, NC (A.S.).
                [15 ]Children’s Hospital of Philadelphia, PA (M.J.S.).
                [16 ]Stanford University, Palo Alto, CA (P.J.W.).
                [17 ]Cooper Medical School of Rowan University, Camden, NJ (A.M.R.).
                Author notes
                Correspondence to: Heart Rhythm Society, 1325 G St NW, Suite 400, Washington, DC 20005. Email clinicaldocs@ 123456hrsonline.org
                Dhanunjaya R. Lakkireddy, Kansas City Heart Rhythm Institute and Research Foundation, HCA Midwest Health, 5100 W 105th St, Suite 200, Overland Park, KS 66211. Email dhanunjaya.lakkireddy@ 123456hcahealthcare.com
                Article
                Accession ID: 00009
                DOI: 10.1161/CIRCEP.120.008999
                PMC ID: 7368851
                PubMed ID: 32530306
                SO-VID: 92e14958-9981-4b42-8f63-e793b8e2958f
                Copyright © © 2020 The Heart Rhythm Society, the American Heart Association, Inc., and the American College of Cardiology Foundation.
                License:

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

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                Categories
                Subject: 10001
                Subject: 10003
                Subject: Special Reports

                Keywords: arrhythmia,covid-19,electrophysiology,pandemic,return to work
                Data availability:
                Keywords: arrhythmia, covid-19, electrophysiology, pandemic, return to work

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