Pacemaker or ICD generator replacements in patients with >6 weeks of battery remaining. Extraction of noninfected devices/leads unless device function is dependent on lead extraction and reimplant. Cardioversion for stable arrhythmias with well-tolerated symptoms. Left atrial appendage (LAA) closure in patients who can be on anticoagulation. Transesophageal echocardiogram for routine assessment of valves or LAA closure devices and cardioversions that can be done after appropriate period of anticoagulation. Implantable loop recorder implants. Tilt-table testing. Perioperative cardiac implantable electrical device management For patients with a CIED undergoing surgery or an endoscopic procedure, it is important to know if the patient is pacemaker dependent, if the patient has an ICD with therapies activated, and the likelihood of electromagnetic interference (EMI) during the procedure (eg, due to electrocautery, etc). In a patient with documented or suspected COVID-19 who is undergoing a procedure with a high likelihood of EMI that could result in pacemaker or ICD malfunction, application of a magnet may be used to suspend antitachyarrhythmia therapy in an ICD or to produce asynchronous pacing in a pacemaker [51]. This allows the patient to safely proceed with the necessary procedure without https://www.uptodate.com/contents/covid-19-arrhythmias-and-conduction-system-disease/print 13/36 7/5/23, 10:34 AM COVID-19: Arrhythmias and conduction system disease - UpToDate reprogramming the CIED before and after the procedure, thereby reducing the risk to health care personnel and preserving PPE. The standard approach to CIED management, which includes in-person reprogramming of the CIED before and after the procedure, is discussed in detail elsewhere. (See "Perioperative management of patients with a pacemaker or implantable cardioverter-defibrillator".) Cardiac implantable electrical device interrogations For most patients, the majority of CIED follow-up device interrogations on modern-era devices can be done either in person or remotely. To maintain social distancing during the COVID-19 pandemic, we recommend remote CIED interrogations for the vast majority of stable patients [51]. Certain situations remain, however, in which an in-person CIED interrogation may be the preferred option, including [30,51]: Suspected CIED malfunction, including: Inappropriate pacemaker pacing or sensing noted on ECG or telemetry monitoring. Failure of ICD to deliver therapy during documented sustained ventricular tachyarrhythmia. Clinically actionable abnormality of CIED or suspicion of the device being at or near end of battery life, noted on remote monitoring, telemetry, or ambulatory monitoring. ICD shocks, presyncope, or syncope concerning for an arrhythmic event to perform programming changes. Untreated sustained ventricular arrhythmias in a patient with an ICD. Evaluation of symptoms suspicious for arrhythmia or abnormal device function in patients who are not enrolled in remote monitoring. Identified need for reprogramming of the CIED, or ICD patients whose device is delivering auditory or vibratory alerts. Assessment of AF in a patient with a stroke and no clear documentation of AF on ECG or telemetry monitoring. For CIED patients requiring urgent or emergent magnetic resonance imaging (MRI) scanning, consider performing a computed tomography scan instead if possible (to minimize the need for additional health care provider or device manufacturer representative contact); if not urgent, delay the MRI. https://www.uptodate.com/contents/covid-19-arrhythmias-and-conduction-system-disease/print 14/36 7/5/23, 10:34 AM COVID-19: Arrhythmias and conduction system disease - UpToDate Patients in the emergency department (or other setting) where remote monitoring is not available. Remote monitoring should be used wherever possible, including the option of asking caregivers to bring the patient's home monitoring equipment to the hospital. After in-person CIED interrogation is performed, it is important to disinfect any parts of the programmer (eg, the programming wand and cord) that have been in contact with the patient. If available, disposable plastic wand coverings may be used to minimize contamination, and consideration should also be given to using a dedicated interrogation device in all settings with known or suspected COVID-19-positive patients. To reduce exposure of health care personnel to CIED patients, a doughnut magnet can be used as an alternative to a complete CIED interrogation or reprogramming [52]. When a hospitalized patient has a pacemaker that does not have remote monitoring capabilities, and proper function of the pacemaker is in question, temporary application of a doughnut magnet over the pacemaker is safe to quickly determine whether or not the pacemaker is capable of delivering pacing stimuli that can capture the heart. Magnet application will place the pacemaker in an asynchronous pacing mode. Depending on the manufacturer and programmed settings, this may include changes in the paced rate, which gives evidence of battery status (ie, elective replacement indicator) or whether there is pacemaker capture. In addition, demonstration of ventricular capture should provide basic reassurance that the pacemaker is functional and can avoid the need for a complete pacemaker interrogation. (See "Perioperative management of patients with a pacemaker or implantable cardioverter-defibrillator".) Patients requiring cardiopulmonary resuscitation (CPR) In general, basic life support and advanced cardiac life support for patients with COVID-19 should be administered in standard fashion, similar to patients without COVID-19, with the following exceptions ( algorithm 1 and algorithm 2) [30,53,55] (see "Adult basic life support (BLS) for health care providers" and "Adult basic life support (BLS) for health care providers", section on 'Resuscitation of patients with COVID-19'): Any personnel caring for a patient with suspected or confirmed COVID-19 should wear the appropriate PPE before entering the room: gown, gloves, eye protection, and a respirator (eg, an N95 respirator). If supply of respirators is limited, the United States Centers for Disease Control and Prevention acknowledges that facemasks are an acceptable alternative (in addition to contact precautions and eye protection), but respirators should be worn during aerosol-generating procedures, which includes intubation. The appropriate PPE should all be donned prior to interacting with the patient, even if this leads to a delay in the provision of resuscitative care [56,57]. https://www.uptodate.com/contents/covid-19-arrhythmias-and-conduction-system-disease/print 15/36 7/5/23, 10:34 AM COVID-19: Arrhythmias and conduction system disease - UpToDate The number of people involved in the resuscitation should be kept to a minimum. This typically includes a team leader, anesthesiologist to manage the airway (if the patient is not already intubated), recorder/scribe, and persons to perform chest compressions, defibrillation, and administration of medications (often, these participants can rotate to allow for periods of rest after performing chest compressions). In COVID-19 patients who are not yet intubated at the time of cardiac arrest, early intubation should be performed by the provider most likely to achieve success on the first pass, utilizing all readily available technology (eg, video laryngoscopy) to optimize first-pass success. Chest compression can be stopped during intubation, and intubation (with a cuffed endotracheal tube) can be performed prior to the standard two minutes of chest compressions and early defibrillation as a means of controlling the potential spread of airborne droplets. If available, mechanical chest compression device may be used in place of manual compressions for adults and adolescents who meet minimum height and weight requirements. For a critically ill patient who is already intubated and in the prone position at the time of arrest, CPR may be attempted with the patient prone by performing compressions of usual depth (ie, 5 to 6 cm) with the hands between the scapulae (over the T4-T7 vertebral bodies) [55,58]. Defibrillation may be performed with the pads in the anterior-posterior position. The patient should be turned to the supine position for resuscitation only if able to do so without equipment disconnections that may lead to aerosolization of viral particles [59]. For out-of-hospital resuscitation efforts, lay rescuers should perform chest compression- only CPR while wearing a face mask or cloth covering. When available, an automated external defibrillator should be applied and used according to the usual protocol. (See "Automated external defibrillators" and "Adult basic life support (BLS) for health care providers", section on 'Defibrillation'.) Initial treatment with antiarrhythmic medications, with the exception of IV magnesium, is not indicated for hemodynamically unstable or pulseless patients. A full discussion of the standard approaches to basic life support and advanced cardiac life support is presented separately. (See "Adult basic life support (BLS) for health care providers" and "Advanced cardiac life support (ACLS) in adults".) SOCIETY GUIDELINE LINKS https://www.uptodate.com/contents/covid-19-arrhythmias-and-conduction-system-disease/print 16/36 7/5/23, 10:34 AM COVID-19: Arrhythmias and conduction system disease - UpToDate Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See "Society guideline links: COVID-19 Index of guideline topics".) INFORMATION FOR PATIENTS UpToDate offers two types of patient education materials, "The Basics" and "Beyond the Basics." th th The Basics patient education pieces are written in plain language, at the 5 to 6 grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more th th sophisticated, and more detailed. These articles are written at the 10 to 12 grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon. Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword(s) of interest.) Basics topic (see "Patient education: COVID-19 overview (The Basics)") Basics topic (see "Patient education: COVID-19 vaccines (The Basics)") SUMMARY AND RECOMMENDATIONS The vast majority of patients presenting with a systemic illness consistent with COVID-19 will not have symptoms or signs of arrhythmias or conduction system disease. However, patients in whom arrhythmias may be seen include patients with myocardial injury, myocardial ischemia, hypoxia, shock, electrolyte disturbances, or those receiving medications known to prolong the QT interval. (See 'Evaluation' above.) All patients in whom COVID-19 is suspected should have a baseline electrocardiogram (ECG) performed at the time of entry into the health care system. Ideally, this would be a 12-lead ECG, but a single-lead or multi-lead ECG from telemetry monitoring may be adequate in this situation to minimize staff exposure to the patient. Continuous ECG monitoring and echocardiography are not required in all patients but can be used in select situations. (See 'Cardiovascular testing' above.) https://www.uptodate.com/contents/covid-19-arrhythmias-and-conduction-system-disease/print 17/36 7/5/23, 10:34 AM COVID-19: Arrhythmias and conduction system disease - UpToDate Patients with sustained torsades de pointes (TdP) usually become hemodynamically unstable, severely symptomatic, or pulseless and should be treated according to standard resuscitation algorithms, including cardioversion/defibrillation ( algorithm 1 and algorithm 2 and algorithm 3). Patients with TdP who are hemodynamically stable on presentation may remain stable or may become unstable rapidly and without warning. These patients should have continuous monitoring and frequent reevaluations due to the potential for rapid deterioration as long as TdP persists. (See 'Patients with polymorphic ventricular tachycardia (torsades de pointes)' above.) Patients receiving QT-prolonging medications should have a baseline QTc value obtained prior to administering the drugs. When patients are receiving any QT-prolonging medications, a dynamic discussion of the benefits and risks of these medications should be ongoing based on the baseline risk (including baseline QTc, electrolyte levels, etc), perceived or actual benefit of therapy, and development of significant QT prolongation or TdP. If the QTc subsequently increases to 500 milliseconds or if the change in QT interval is 60 milliseconds from the baseline ECG, electrolytes (notably potassium and magnesium) should be corrected to the normal range (if needed), and continuous inpatient ECG telemetry should be maintained, with additional management changes that may include dose adjustment or medication withdrawal. (See 'Patients receiving therapies that prolong the QT interval' above.) The approach to caring for hospitalized patients with documented or suspected COVID-19 differs slightly, with the intent to reduce exposure to (and spread of) COVID-19 to health care providers. In general, the number of persons interacting directly with the patient and the time spent in the room should be minimized. Social distancing should be maintained, with both the patient and other members of the health care team. (See 'Inpatient care and consultation' above and 'Arrhythmia-related procedures' above.) The approaches to cardiac implantable electrical device (CIED) interrogations and perioperative CIED management are summarized in the text. Strategies to avoid in-person device interrogations should be deployed. (See 'Cardiac implantable electrical device interrogations' above and 'Perioperative cardiac implantable electrical device management' above.) In general, basic life support and advanced cardiac life support for patients with COVID-19 should be administered in standard fashion as for patients without COVID-19. However, any personnel caring for a patient with suspected or confirmed COVID-19 should wear the appropriate personal protective equipment (including gown, gloves, eye protection, and a respirator or face mask) before entering the room, the number of people involved in the https://www.uptodate.com/contents/covid-19-arrhythmias-and-conduction-system-disease/print 18/36 7/5/23, 10:34 AM COVID-19: Arrhythmias and conduction system disease - UpToDate resuscitation should be kept to a minimum, and early intubation should be performed for patients who are not yet intubated at the time of cardiac arrest. (See 'Patients requiring cardiopulmonary resuscitation (CPR)' above.) Use of UpToDate is subject to the Terms of Use. REFERENCES 1. World Health Organization. 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Cheung CC, Davies B, Gibbs K, et al. Multi-lead QT screening is necessary for QT measurement: implications for management of patients in the COVID-19 era. JACC Clin Electrophysiol 2020. 33. Giudicessi JR, Noseworthy PA, Friedman PA, et al. Urgent guidance for navigating and circumventing the QTc prolonging and torsadogenic potential of possible pharmacotherapies for COVID-19. Mayo Clin Proc 2020. 34. Panchal AR, Berg KM, Kudenchuk PJ, et al. 2018 American Heart Association Focused Update on Advanced Cardiovascular Life Support Use of Antiarrhythmic Drugs During and Immediately After Cardiac Arrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2018; 138:e740. 35. US FDA. Coronavirus (COVID-19) Update: FDA Revokes Emergency Use Authorization for Chl oroquine and Hydroxychloroquine. 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A need for prone position CPR guidance for intubated and non-intubated patients during the COVID-19 pandemic. Resuscitation 2020; 151:135. Topic 127551 Version 41.0 https://www.uptodate.com/contents/covid-19-arrhythmias-and-conduction-system-disease/print 23/36 7/5/23, 10:34 AM COVID-19: Arrhythmias and conduction system disease - UpToDate GRAPHICS ACLS cardiac arrest algorithm for suspected or confirmed COVID-19 patients https://www.uptodate.com/contents/covid-19-arrhythmias-and-conduction-system-disease/print 24/36 7/5/23, 10:34 AM COVID-19: Arrhythmias and conduction system disease - UpToDate https://www.uptodate.com/contents/covid-19-arrhythmias-and-conduction-system-disease/print 25/36 7/5/23, 10:34 AM COVID-19: Arrhythmias and conduction system disease - UpToDate PPE: personal protective equipment; CPR: cardiopulmonary resuscitation; IV: intravenous; IO: intraosseous. Refer to UpToDate topics on post-cardiac arrest management for additional information. Reproduced with permission. 10.1161/CIRCULATIONAHA.120.047463. Copyright 2020 American Heart Association, Inc. Graphic 127851 Version 9.0 https://www.uptodate.com/contents/covid-19-arrhythmias-and-conduction-system-disease/print 26/36 7/5/23, 10:34 AM COVID-19: Arrhythmias and conduction system disease - UpToDate BLS healthcare provider acute cardiac arrest algorithm for suspected or confirm COVID-19 patients PPE: personal protective equipment; AED: automatic external defibrillator; CPR: cardiopulmonary resuscitatio advanced life support. Reproduced with permission. 10.1161/CIRCULATIONAHA.120.047463. Copyright 2020 American Heart Association, Inc. https://www.uptodate.com/contents/covid-19-arrhythmias-and-conduction-system-disease/print 27/36 7/5/23, 10:34 AM COVID-19: Arrhythmias and conduction system disease - UpToDate Graphic 127846 Version 9.0 https://www.uptodate.com/contents/covid-19-arrhythmias-and-conduction-system-disease/print 28/36 7/5/23, 10:34 AM COVID-19: Arrhythmias and conduction system disease - UpToDate Adult cardiac arrest algorithm https://www.uptodate.com/contents/covid-19-arrhythmias-and-conduction-system-disease/print 29/36 7/5/23, 10:34 AM COVID-19: Arrhythmias and conduction system disease - UpToDate https://www.uptodate.com/contents/covid-19-arrhythmias-and-conduction-system-disease/print 30/36 7/5/23, 10:34 AM COVID-19: Arrhythmias and conduction system disease - UpToDate Reprinted with permission. Highlights of the 2020 American Heart Association Guidelines for CPR and ECC. Copyright 2020 American Association, Inc. Graphic 129983 Version 9.0 https://www.uptodate.com/contents/covid-19-arrhythmias-and-conduction-system-disease/print 31/36 7/5/23, 10:34 AM COVID-19: Arrhythmias and conduction system disease - UpToDate Some reported causes and potentiators of the long QT syndrome Congenital Jervell and Lange-Nielsen syndrome (including "channelopathies") Romano-Ward syndrome Idiopathic Acquired Metabolic disorders Other factors Androgen deprivation therapy Hypokalemia Myocardial GnRH agonist/antagonist therapy ischemia or Hypomagnesemia Bilateral surgical orchiectomy infarction, Hypocalcemia Diuretic therapy via electrolyte disorders especially with Starvation particularly hypokalemia and hypomagnesemia prominent T-wave Anorexia nervosa Herbs inversions Liquid protein diets Cinchona (contains quinine), iboga Intracranial Hypothyroidism (ibogaine), licorice extract in overuse via disease electrolyte disturbances Bradyarrhythmias HIV infection Sinus node Hypothermia dysfunction Toxic exposure: AV block: Second or Organophosphate third degree insecticides Medications* High risk Adagrasib Cisaparide Lenvatinib Selpercatinib (restricted Ajmaline Levoketoconazole Sertindole availability) Amiodarone Methadone Sotalol Delamanid Arsenic trioxide Mobocertinib Terfenadine Disopyramide Astemizole Papavirine Vandetanib Dofetilide (intracoronary) Bedaquline Vernakalant Dronedarone Procainamide Bepridil Ziprasidone Haloperidol (IV) Quinidine Chlorpromazine Ibutilide Quinine Ivosidenib Moderate risk Amisulpride (oral) Droperidol Inotuzumab ozogamacin Propafenone Azithromycin Encorafenib Propofol Isoflurane Capecitabine Entrectinib Quetiapine Carbetocin Erythromycin Ribociclib https://www.uptodate.com/contents/covid-19-arrhythmias-and-conduction-system-disease/print 32/36 7/5/23, 10:34 AM COVID-19: Arrhythmias and conduction system disease - UpToDate Certinib Escitalopram Levofloxacin Risperidone (systemic) Chloroquine Etelcalcetide Saquinavir Lofexidine Citalopram Fexinidazole Sevoflurane Meglumine Clarithromycin Flecainide Sparfloxacin antimoniate Clofazimine Floxuridine Sunitinib Midostaurin Clomipramine Fluconazole Tegafur Moxifloxacin Clozapine Fluorouracil Terbutaline Nilotinib (systemic) Crizotinib Thioridazine Olanzapine Flupentixol Dabrafenib Toremifene Ondansetrol (IV > Gabobenate Dasatinib Vemurafenib oral) dimeglumine Deslurane Voriconazole Osimertinib Gemifloxacin Domperidone Oxytocin Gilteritinib Doxepin Pazopanib Halofantrine Doxifluridine Pentamidine Haloperidol (oral) Pilsicainide Imipramine Pimozide Piperaquine Probucol Low risk Albuterol Fingolimod Mequitazine Ranolazine (due to bradycardia) Alfuzosin Fluoxetine Methotrimeprazine Relugolix Amisulpride (IV) Fluphenazine Metoclopramide (rare reports) Rilpivirine Amitriptyline Formoterol Metronidazole Romidepsin Anagrelide Foscarnet (systemic) Roxithromycin Apomorphine Fostemsavir Mifepristone Salmeterol Arformoterol Gadofosveset Mirtazapine Sertraline Artemether- Glasdegib Mizolastine lumefantrine Siponimod Goserelin Nelfinavir Asenapine Solifenacin Granisetron Norfloxacin Atomoxetine Sorafenib Hydroxychloroquine Nortriptyline Benperidol (rare reports) Sulpiride Ofloxacin (systemic) Bilastine Hydroxyzine Tacrolimus Olodaterol (systemic) Bosutinib Iloperidone Osilodrostat Tamoxifen Bromperidol Indacaterol Oxaliplatin Telavancin Buprenorphine Itraconazole Ozanimod Telithromycin Buserelin Ketoconazole (systemic) Pacritinib Teneligliptin Ciprofloxacin (Systemic) Lacidipine Paliperidone Tetrabenazine Cocaine (Topical) Lapatinib Panobinostat Trazodone Degarelix Lefamulin Pasireotide Triclabendazole https://www.uptodate.com/contents/covid-19-arrhythmias-and-conduction-system-disease/print 33/36 7/5/23, 10:34 AM COVID-19: Arrhythmias and conduction system disease - UpToDate Desipramine Leuprolide Pefloxacin Triptorelin Deutetrabenazine Leuprolide- Periciazine Tropisetron norethindrone Dexmedetomidine** Pimavanserin Vardenafil Levalbuterol Dolasetron Pipamperone Vilanterol Levomethadone Donepezil Pitolisant Vinflunine Lithium Efavirenz Ponesimod Voclosporin Loperamide in Eliglustat Primaquine Vorinostat overdose Eribulin Promazine Zuclopenthixol Lopinavir Ezogabine Radotinib Macimorelin Mefloquine This is not a complete list of all corrected QT interval (QTc)-prolonging drugs and does not include drugs with either a minor degree or isolated association(s) with QTc prolongation that appear to be safe in most patients but may need to be avoided in patients with congenital long QT syndrome depending upon clinical circumstances. A more complete list of such drugs is available at the CredibleMeds website. For clinical use and precautions related to medications and drug interactions, refer to the UpToDate topic review of acquired long QT syndrome discussion of medications and the Lexicomp drug interactions tool. AV: atrioventricular; IV: intravenous; QTc: rate-corrected QT interval on the electrocardiogram. Classifications provided by Lexicomp according to US Food & Drug Administration guidance: Clinical Evaluation of QT/QTc Interval Prolongation and Proarrhythic Potential for Non-Antiarrhythmic Drugs Questions and Answers; Guidance for Industry US Food and Drug Administration, June 2017 (revision 2) available at: https://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM [1,2] 073161.pdf with additional data from CredibleMeds QT drugs list . The use of other classification criteria may lead to some agents being classified differently by other sources. Not available in the United States. In contrast with other class III antiarrhythmic drugs, amiodarone is rarely associated with torsades de pointes; refer to accompanying text within UpToDate topic reviews of acquired long QT syndrome. Withdrawn from market in most countries due to adverse cardiovascular effects. IV amisulpride antiemetic use is associated with less QTc prolongation than the higher doses administered orally as an antipsychotic. Other cyclic antidepressants may also prolong the QT interval; refer to UpToDate clinical topic on cyclic antidepressant pharmacology, side effects, and separate UpToDate topic on tricyclic antidepressant poisoning. The "low risk" category includes drugs with limited evidence of clinically significant QTc prolongation or TdP risk; many of these drugs have label warnings regarding possible QTc effects or recommendations to avoid use or increase ECG monitoring when combined with other QTc prolonging drugs. https://www.uptodate.com/contents/covid-19-arrhythmias-and-conduction-system-disease/print 34/36 7/5/23, 10:34 AM COVID-19: Arrhythmias and conduction system disease - UpToDate Rarely associated with significant QTc prolongation at usual doses for treatment of opioid use disorder, making buprenorphine a suitable alternative for patients with methadone-associated QTc prolongation. Refer to UpToDate clinical topic reviews. * The United States FDA labeling for the sublingual preparation of dexmedetomidine warns against use in patients at elevated risk for QTc prolongation. Both intravenous (ie, sedative) and sublingual formulations of dexmedetomidine have a low risk of QTc prolongation and have not been implicated in TdP. Over-the-counter; available without a prescription. Not associated with significant QTc prolongation in healthy persons. Refer to UpToDate clinical topic for potential adverse cardiovascular (CV) effects in patients with CV disease. Data from: 1. Lexicomp Online. Copyright 1978-2023 Lexicomp, Inc. All Rights Reserved. 2. CredibleMeds QT drugs list website sponsored by Science Foundation of the University of Arizona. Available at http://crediblemeds.org/. Graphic 57431 Version 142.0 https://www.uptodate.com/contents/covid-19-arrhythmias-and-conduction-system-disease/print 35/36 7/5/23, 10:34 AM COVID-19: Arrhythmias and conduction system disease - UpToDate Contributor Disclosures Jordan M Prutkin, MD, MHS, FHRS No relevant financial relationship(s) with ineligible companies to disclose. Bradley P Knight, MD, FACC Grant/Research/Clinical Trial Support: Abbott [Electrophysiology]; Atricure [Electrophysiology]; Biosense Webster [Electrophysiology]; Biotronik [Electrophysiology]; Boston Scientific [Electrophysiology]; BSCI [Electrophysiology]; MDT [Electrophysiology]; Philips [Electrophysiology]. Consultant/Advisory Boards: Abbott [Electrophysiology]; Atricure [Electrophysiology]; Biosense Webster [Electrophysiology]; Biotronik [Electrophysiology]; Boston Scientific [Electrophysiology]; BSCI [Electrophysiology]; CVRx [Heart failure]; MDT [Electrophysiology]; Philips [Electrophysiology]; Sanofi [Arrhythmias]. Speaker's Bureau: Abbott [Electrophysiology]; Biosense Webster [Electrophysiology]; Biotronik [Electrophysiology]; Boston Scientific [Transeptal catheterization]; BSCI [Electrophysiology]; MDT [Electrophysiology]. All of the relevant financial relationships listed have been mitigated. Nisha Parikh, MD, MPH No relevant financial relationship(s) with ineligible companies to disclose. Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by vetting through a multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence. Conflict of interest policy https://www.uptodate.com/contents/covid-19-arrhythmias-and-conduction-system-disease/print 36/36