Background: Isoproterenol, a non-specific beta agonist, is commonly used during electrophysiology studies (EPS). However, with the significant increase in the price of isoproterenol in 2015 and the increasing number of catheter ablations performed, the cost implications cannot be ignored. Dobutamine is a less expensive synthetic compound developed from isoproterenol with a similar mechanism to enhance cardiac conduction and shorten refractoriness, thus making it a feasible substitute with a lower cost. However, the use of dobutamine for EPS has not been well-reported in the literature. Objective: To determine the site-specific effects of various doses of dobutamine on cardiac conduction and refractoriness and assess its safety during EPS. Methods: From February 2020 to October 2020, 40 non-consecutive patients scheduled for elective EPS, supraventricular tachycardia, atrial fibrillation, and premature ventricular contraction ablations at a single center were consented and prospectively enrolled to assess the effect of dobutamine on the cardiac conduction system. At the end of each ablation procedure, measures of cardiac conduction and refractoriness were recorded at baseline and with incremental doses of dobutamine at 5, 10, 15, and 20 mcg/kg/min. For the primary analysis, the change per dose of dobutamine from baseline to each dosing level of dobutamine received by the patients, comparing atrioventricular node block cycle length (AVNBCL), ventricular atrial block cycle length (VABCL) and sinus cycle length (SCL), was tested using mixed-effect regression. For the secondary analysis, dobutamine dose level was tested for association with relative changes from baseline of each electrophysiologic parameter (SCL, AVNBCL, VABCL, atrioventricular node effective refractory period (AVNERP), AH, QRS, QT, atrial effective refractory period (AERP), ventricular effective refractory period (VERP), using mixed-effect regression. Changes in systolic and diastolic blood pressures were also assessed. The Holm-Bonferroni method was used to adjust for multiple testing. Results: For the primary analysis there was no statistically significant change of AVNBCL and VABCL relative to SCL from baseline to each dose level of dobutamine. The SCL, AVNBCL, VABCL, AVNERP, AERP, VERP and the AH, and QT intervals all demonstrated a statistically significant decrease from baseline to at least one dose level with incremental dobutamine dosing. Two patients (5%) developed hypotension during the study and one patient (2.5%) received a vasopressor. Two patients (5%) had induced arrhythmias but otherwise no major adverse events were noted. Conclusion: In this study, there was no statistically significant change of AVNBCL and VABCL relative to SCL from baseline to any dose level of dobutamine. As expected, the AH and QT intervals, and the VABCL, VERP, AERP and AVNERP all significantly decreased from baseline to at least one dose level with an escalation in dobutamine dose. Dobutamine was well-tolerated and safe to use during EPS.

Background: It is common practice to observe patients during an overnight stay (ONS) following a catheter ablation procedure for the treatment of atrial fibrillation (AF). Objectives: To investigate the safety and economic impact of a same day discharge (SDD) protocol after cryoballoon ablation for treatment of AF in high-volume, geographically diverse US hospitals. Methods: We retrospectively reviewed 2,374 consecutive patients (1,119 SDD and 1,180 ONS) who underwent cryoballoon ablation for AF at three US centers. Baseline characteristics and longer-term safety were recorded during follow-up. The mean cost of an ONS was used to evaluate yearly cost savings as a function of the percentage of SDD cases/yearr. Results: There was no difference between SDD and ONS in the 30 day total complication rate [n=15 (1.26%) versus n=24 (2.03%); p=0.136 respectively]. The most common complication was hematoma in both the SDD (n=8; 0.67%) and ONS (n=11; 0.93%) cohorts. Sensitivity analysis demonstrated that when 50% of every 100 patients treated were discharged the same day, hospital cost savings ranged from $45,825 to $83,813 per year across US hospitals. Conclusions: SDD following cryoballoon ablation for AF appears to be safe and is associated with cost savings across different US hospitals.

Background: Coronavirus disease (COVID-19) has overwhelmed healthcare systems worldwide often at the cost of patients with serious non-COVID-19 conditions. Outcomes and risks of contracting COVID-19 in patients hospitalized during the pandemic are unknown. Objective: To report our experience in safely performing electrophysiology procedures during the COVID-19 pandemic. Methods: We examined non-COVID-19 patients who underwent electrophysiology procedures during the peak of the pandemic between March 16, 2020 and May 11, 2020 at seven Northwell Health hospitals. We developed a priority algorithm to stratify inpatients and outpatients requiring electrophysiology procedures and instituted a protocol to minimize hospital length of stay (LOS). All patients underwent post discharge 30-day tele-health follow-up and chart review up to 150 days. Results: A total of 217 patients underwent electrophysiology procedures, of which 86 (39%) patients were outpatients. A total of 108 (49.8%) patients had a LOS less than 24 hours, including 74 device implantations and generator changes, 24 cardioversions, five ablations, and one electrophysiology study. There were eleven (5.1%) procedure or arrhythmia related re-admissions and two (0.9%) minor procedural complications. Overall average hospital LOS was 83.4±165.1 hours and a median of 24.0 hours. For outpatient procedures, average hospital LOS was 9.4±13.4 hours and a median of 4.3 hours. Overall follow-up time was 83.9 ±42 days and a median of 84 days. During follow-up, two (0.9%) patients tested positive for COVID-19 and recovered uneventfully. No deaths occurred. Conclusion: During the peak of the COVID-19 pandemic, patients safely underwent essential electrophysiological procedures without increased incidence of acquiring COVID-19.

The COVID-19 pandemic has necessitated rapid implementation of innovative strategies to manage patients remotely, in order to reduce the risk of community and nosocomial transmission. This case demonstrates the use of an Apple Watch to monitor for arrhythmias and QT prolongation in a patient with COVID-19 infection during home isolation.