Aim: To evaluate prevalence of heart failure (HF) medical treatment and its impact on ventricular arrhythmia (VA) and survival among patients implanted with primary prevention ICD/CRTD. Methods and results: The association of treatment and dose (% guideline recommended target) of beta-blockers (BB), Angiotensin-antagonists (AngA), Mineralocorticoid-antagonsits (MRA), and Anti-Arrhythmic Drugs (AAD) after ICD/CRTD implant with VA episodes and mortality was analyzed. We included 186 patients, meanSD age 66.412 years, 15.1% female, 79(42.5%) implanted with an ICD and 107(57.5%) with CRTD. During 3.8 [2.1;6.7] (median[IQR]) years; 52(28%) had VA and 77(41.4%) died. Treatment (medication, % of patients) included: BB (83%), AngA (87%), MRA (59%), and AAD (43.5%). Median doses were 25[12.5;50]% of target for BB or AngA and 25[0;50]% of target for MRA. Treatment with >25% target dose of BB was associated with reduced incident VA. In a multivariable model including age, gender, diabetes, heart rate, and medication doses, increased BB dose was significantly and independently associated with reduced VA (HR 0.443 95%CI 0.222-0.885; p=0.021). On multivariable model for overall mortality including age, gender, renal disease, VA, and medical treatment; VA was associated with increased mortality (HR 2.672; 95% CI 1.429-4.999; p=0.002) and AngA treatment was significantly and independently associated with reduced mortality (HR 0.515; 95% CI 0.285-0.929; p=0.028). Conclusions: In this cohort of real-life HF patients discharged after ICD/CRTD implant, most of the patients were prescribed with guideline-based HF medications albeit with low doses. Higher BB dose was associated with reduced VA, while treatment with AngA was associated with improved survival.

Objectives: A significant proportion of COVID-19 patients may have cardiac involvement including arrhythmias. Although arrhythmia characterization and possible predictors were previously reported, there are conflicting data regarding the exact prevalence of arrhythmias. Clinically applicable algorithms to classify COVID patients’ arrhythmic risk are still lacking, and are the aim of our study. Methods: We describe a single center cohort of hospitalized patients with a positive nasopharyngeal swab for COVID-19 during the initial Israeli outbreak between 1/2/2020 –30/5/2020. The study’s outcome was any documented arrhythmia during hospitalization, based on daily physical examination, routine ECG’s, periodic 24-hour Holter, and continuous monitoring. Multivariate analysis was used to find predictors for new arrhythmias and create classification trees for discriminating patients with high and low arrhythmic risk. Results: Out of 390 COVID-19 patients included, 28 (7.2%) had documented arrhythmias during hospitalization, including: 23 atrial tachyarrhythmias, combined atrial fibrillation (AF) and ventricular fibrillation, ventricular tachycardia storm, and 3 bradyarrhythmias. Only 7/28 patients had previous arrhythmias. Our study showed significant correlation between disease severity and arrhythmia prevalence (p<0.001) with a low arrhythmic prevalence among mild disease patients (2%). Multivariate analysis revealed background heart failure (CHF) and disease severity are independently associated with overall arrhythmia while age, CHF, disease severity, and arrhythmic symptoms are associated with tachyarrhythmias. A novel decision tree using age, disease severity, CHF, and troponin levels was created to stratify patients into high and low risk for developing arrhythmia. Conclusions: Dominant arrhythmia among COVID-19 patients is AF. Arrhythmia prevalence is dependent on age, disease severity, CHF, and troponin levels. A novel simple Classification tree, based on these parameters, can discriminate between high and low arrhythmic risk patients.