Cardiac electrophysiologists (EPs) – like many other medical and surgical subspecialists in New York City – are volunteering and being reassigned to care for ill patients with coronavirus (COVID-19), their cath lab skills put to rest for the time being.
EP is a procedure-based field, comprised of many “elective” cases that nonetheless improve symptoms and extend life. Amidst the pandemic, EP labs throughout the country are ramping down to solely handle emergent cases in order to protect our patients and preserve critically-low supplies.
There are several relevant EP characteristics of COVID-19 care. Unproven medications like hydroxychloroquine and lopinavir/ritonavir may prolong the QT interval and lead to polymorphic ventricular tachycardia (VT). The cardiac injury, myocarditis component of COVID-19 likely effects the heart’s electrical system. There have been published reports of considerable arrhythmia frequency and anecdotal reports of sinus arrest with junctional rhythm, VT, and ventricular fibrillation.
In a way, viral transmission is similar to electricity passing through cardiac cells, conducting forward from the steady sinus node, moving down the current stream, on and on, over and over again until the founder impulse itself terminates or the “host” heart is no longer alive.
In the same way that viruses rather, unfortunately, “connect” one human to another by means of transmission, the conduction cells in the heart connect to each other by means of gap junctions, “infecting” one cell after the next with electricity, culminating in the inevitable heartbeat.
An incessant tachycardia represents electricity run amok, unimpeded to seed the heart itself with impulses until the “host’s” cardiac performance is destroyed. An arrhythmia can diminish the function of distant organs, like an untreated virus spreading through a population and invading far-off countries.
There is a psychological aspect to both COVID-19 and arrhythmias. Societal paranoia recalls the vague fear of a patient in VT right before they are shocked, or the anxiety of atrial fibrillation with a rapid ventricular response. The post-traumatic stress from a shock can overwhelm a patient’s psyche, much like COVID-19 has overtaken the collective consciousness.
COVID-19 has revealed that the medical world’s heart collectively beats as one. During this pandemic, the selfless heroism of doctors, nurses, physician-assistants, nurse-practitioners, and respiratory therapists at the frontline is infectious and inspiring to their colleagues. The conditions are desperate and anxiety-provoking, described as “war zones,” and the tools to safely perform their jobs are insufficient.
In cardiac EP, when a crucial limb of a tachycardia circuit is burned with an ablation catheter, it generally isn’t coming back. A line of electrical “block” is created. “Block” is the goal in EP.
In the same vein, health care professionals of the world over are prescribing every measure within their power to “block” this virus.
In addition to treating sick patients, they advocate for public health measures like physical distancing, home quarantine, and hand hygiene. They call out for drastic governmental and entrepreneurial intervention to provide more testing, masks, gowns, hospital beds, and mechanical ventilators to help “block” this virus.
This is the scariest time to be a health care professional in recent memory. Patients are dying at high rates, and the treatment teams themselves are especially vulnerable. An urgent increase in the production and distribution of protective equipment, ventilators, and hospital beds is needed to safely care patients. Everyone – including sub-subspecialists – is ready to do their part to “block” this virus.
The coronavirus pandemic has nothing to do with why I went into cardiac electrophysiology, but it has everything to do with why I became a doctor.
Geoffrey Rubin is a cardiologist and can be reached on Twitter @geoffrey_rubin.
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