Table 1.
Timeline of patient’s presentation from COVID-19 diagnosis until the latest cardiology encounter
| Day 0 |
COVID-19 onset FLU-like symptoms managed by symptomatic treatment |
| Day 9 |
COVID-19 resolution Flu-like symptoms resolution with residual cough |
| Day 14 | Cough resolution |
| Month 1 |
Palpitations onset Palpitations ≈ 5 times / day, unrelated to activity or any other precipitating factor |
| Month 7 |
Primary care physician encounter Patient first presented to a physician as symptoms became uncontrollable Referral to a pulmonologist: physical examination, and spirometry and pulmonary function tests were normal Continuous Holter monitor ordered and referral to cardiology |
| Month 7.5–8 |
First Zio XT patch Report: 13,485 VT runs +/- 45 s of symptom onset, PVC burden 6.2% |
| Month 9 |
First cardiology encounter Given Zio XT patch report, metoprolol 25 mg XL was started Cardiac DE-MRI: mild delayed enhancement at the basal-to-mid RV insertion points in a nonischemic pattern |
| Month 12.5 |
Follow-up appointment Persistent palpitations → metoprolol increased to 37.5 mg XL |
| Month 13–13.5 |
Second Zio XT patch Report: 23,567 VT runs +/- 45 s of symptom onset, PVC burden 7.7% |
| Month 14 |
6-days hospitalization 18-hour Holter: 37 VT runs, PVC burden 7.7% Flecainide initiation and titration to 75 mg twice a day Repeat 22.5-h Holter: 0 VT runs, PVC burden 2% Repeat DE-MRI: mild delayed enhancement at the basal-to-mid RV insertion points in a nonspecific, nonischemic pattern PET/CT cardiac perfusion: no evidence of scarred myocardium PET/CT cardiac viability: no evidence of active inflammation with diffuse myocardial FDG uptake and no myocardial scar |
| Month 15–15.5 |
Repeat Zio XT patch off-flecainide Report: 1263 VT runs, PVC burden 6.5% |
| Month 16.5 |
Follow-up cardiology encounter Flecainide 75 mg twice a day maintenance |
| Month 18–22 |
Palpitations persistence Palpitations still bothersome for the patient Flecainide dose increased to 150 mg twice a day |
| Month 23– 23.5 |
Repeat Zio XT patch Report: O VT runs, PVC burden 7.8% |
| Month 24 |
Echocardiography Report: Normal with mild LV dilation, EF = 65% |
| Month 24.5–25 |
Repeat Zio XT patch Report: 0 VT runs, PVC burden 4.5 % |
| Month 28 |
Latest cardiology encounter Symptoms resolution—very occasional palpitations on flecainide 150 mg |
| Month 35 |
48-h Holter monitor Report: 0 VT runs, PVC burden 30% |
| Month 43 |
Electrophysiology with ablation Catheter ablation around septal RVOT |
Manufacturer Information: Zio XT patch (iRhythm Technologies, Inc, San Francisco, CA); Holter monitor (iRhythm Technologies, Inc, San Francisco, CA).
CT, computed tomography; DE-MRI, delayed enhancement magnetic resonance imaging; EF, ejection fraction; FDG, fluorodeoxyglucose; LV, left ventricle; PET: positron emission tomography; PVC, premature ventricular contraction; RV, right ventricle; RVOT, right ventricle outflow tract; VT, ventricular tachycardia.