Cardiac Arrhythmias in COVID 19 Infection
Severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) the virus that causes COVID 19, has affected >1 million people worldwide.1 As of this writing, >60 000 people have died as a result of this virus in the United States alone,2 and New York City has over 167 000 confirmed coronavirus disease 2019 (COVID 19) cases, the highest number of any city in the United States. New York City is now considered a COVID 19 epicenter. While this disease predominantly affects the lungs, often leading to pneumonia and acute respiratory distress syndrome, adverse effects on the heart have also been described.3 Electrophysiological issues are increasingly recognized as a disease manifestation, with one study reporting arrhythmias in 44% of individuals with severe illness.4 Sudden cardiac death has also been described anecdotally.5 However, the type and severity of arrhythmias associated with COVID 19 have not been described. In this article, we present 4 cases that highlight the spectrum of arrhythmias observed in patients with COVID 19 infection. New York Presbyterian/Columbia University Irving Medical Center is located in the New York City COVID19 epicenter and herein, we describe the clinical presentations we have seen and discuss decision making regarding therapeutic options, acknowledging difficulties pertaining to resource conservation and healthcare worker safety. This study was approved by the Columbia University Institutional Review Board, and procedures followed were in accordance with institutional guidelines. Due to the nature of the study, written informed consent was not required. The authors declare that all supporting data are available within the article. CASE 1: HIGH GRADE ATRIOVENTRICULAR BLOCK
Circulation. Arrhythmia and electrophysiology