COVID-19

The AICC wish to provide some guidance for its members in advising their patients with ICCs about COVID-19. This advice is consistent with that submitted to Specialist Commissioning and expected to be available on-line from NHS England and through 111.

All patients should follow relevant government advice on COVID-19 provided by the 111 website and call line.

Patients who are at increased risk of complications of infection who will require strict self-isolation to reduce the chance of contracting the virus:

  1. Dilated, arrhythmogenic and hypertrophic cardiomyopathy patients with LV impairment and/or symptomatic left heart failure.
  2. Arrhythmogenic cardiomyopathy patients with RV impairment and/or symptomatic right heart failure.
  3. Symptomatic hypertrophic cardiomyopathy with or without significant obstruction.

Patients who may require special instructions:

  1. Patients with Brugada syndrome and/or sodium channel disease have a potential for increased risk of arrhythmia during fever. All patients should self-treat with paracetamol immediately if they develop signs of fever and self-isolate.
  1. If patients with Brugada syndrome and/or sodium channel disease without an ICD, develop a persistent high fever (>38.5C) despite paracetamol, they should contact 111 by phone, stating their condition, and may need to attend A+E* as advised by the algorithm below. If attendance is necessary, A+E will need to be advised either by 111 or by the patient that they will attend to allow assessment by staff with suitable protective equipment. Assessment should include an ECG** and monitoring for arrhythmia. If an ECG shows the type 1 Brugada ECG pattern, then the patient will need to be observed until fever and/or the ECG pattern resolves. If all ECGs show no sign of the type 1 ECG pattern, then they can go home to self-isolate whether there is persistent fever or not. Patients with fever who have an ICD can isolate at home and follow guidance provided by 111.

* A+E attendance may be regulated according to the capacity of service and risk of COVID-19 infection.

** ideally three different ECGs with V1 and V2 in the 4th, 3rd and 2nd intercostal spaces should be taken.

The algorithm clarifies the steps to be taken for patients according to fever related risk (https://doi.org/10.1016/j.hrthm.2020.03.024). Lower risk cases and patients with ICDs, who are free of symptoms of arrhythmia during fever, have less potential benefit from going to hospital for monitoring with the risks of COVID-19 exposure and infection being greater.

3. Long QT syndrome patients infected with COVID-19 who receive antivirals and/or chloroquine/hydroxychloroquine will require ECG monitoring and electrolyte correction in case of exacerbation of QT prolongation and increased risk of arrhythmias during therapy (https://doi.org/10.1016/j.hrthm.2020.03.024).