Arrhythmia Monitoring Practice Update Is Published by International Organizations
A new practice update is providing guidance on telehealth and arrhythmia monitoring during and after the COVID-19 pandemic.
The guidance document—which was developed by the Heart Rhythm Society (HRS), the European Heart Rhythm Association (EHRA), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), the American College of Cardiology (ACC), and the American Heart Association (AHA)—outlines how digital health may facilitate electrophysiology practice for patients with arrhythmia.
“The pandemic poses challenges to electrophysiologists at several levels,” the document authors write. “Hospitalized COVID-19-positive patients may have preexisting arrhythmias, develop new arrhythmias, or be placed at increased arrhythmic risk from therapies for COVID-19.”
The document includes guidance for treating arrythmias not only among patients with COVID-19, but also among those without the virus. The guidance is sectioned into 3 main parts:
- Monitoring strategies during a pandemic: here to stay
- Therapy for COVID-19 and potential electrical effects
- The future: digital medicine catalyzed by the pandemic
In the first section, the document authors suggest that monitoring strategies should focus on selecting high-risk patients in need of close surveillance. To preserve personal protective equipment, the authors also suggest that practitioners use alternative remote recording devices.
When there is concern for clinical deterioration or when patients have cardiovascular risk factors and/or are receiving essential QT-prolonging medications, telemetry is reasonable for inpatient monitoring, according to the authors.
Guidance on outpatient monitoring, as well as examples of commonly used platforms for telehealth, examples of remote electrocardiogram and heart rate monitoring devices, and barriers to implementation are also included.
In the second section, the authors suggest that the risk vs benefit of QT-prolonging COVID-19 therapies for patients receiving prior antiarrhythmic therapy should be carefully considered.
The effect that experimental pharmacological therapies for COVID-19 have on QTc and proarrhythmia, as well as guidance on electrocardiographic monitoring during clinical trials, are also included.
“Today’s new reality will likely define medicine going forward,” according to the final section, which highlights the benefits of wearable and smartphone-based devices as well as of remote cardiovascular implantable electronic device monitoring.
“The crisis precipitated by the pandemic has catalyzed the adoption of remote patient management across many specialties and for heart rhythm professionals, in particular,” the document authors wrote. “This practice is here to stay—it will persist even if other less arrhythmogenic treatment strategies evolve for COVID-19 and after the pandemic has passed. This is an opportunity to embed and grow remote services in everyday medical practice worldwide.”
—Colleen Murphy
Reference:
Varma N, Marrouche NF, Aguinaga L, et al. HRS/EHRA/APHRS/LAHRS/ACC/AHA worldwide practice update for telehealth and arrhythmia monitoring during and after a pandemic. Heart Rhythm. Published online June 11, 2020. doi:10.1016/j.hrthm.2020.06.010