Table 4.

General recommendations for AF management in patients with COVID-19

General recommendations
ECG is recommended in all patients with suspected COVID-19 infection at admission.
Is recommended to perform an ECG before the initiation of antiarrhythmic drug and ECG monitoring after initiation.
QT interval should be monitored in patients treated with class IA, IC, and III AADs, hydroxychloroquine/chloroquine, macrolide, fingolimod, and/or lopinavir/ritonavir.
Drug management
Classes IA and IC are contraindicated in COVID-19 patients on fingolimod.
Beta-blockers are recommended as a first-line therapy to rate control.
Calcium channel blockers are not recommended in acute myocarditis patients with decompensated HF.
Digoxin can be used in CHF or combination with β-blockers or calcium channel blockers for rate control.
Heparin is the anticoagulant of choice in hospitalized COVID-19 patients with AF, especially if patients are being treated with lopinavir/ritonavir.
Direct oral anticoagulants can be used in AF patients with COVID-19 after discharge without lopinavir/ritonavir.
Amiodarone can be used for rhythm and rate control in critically ill COVID-19 patients with CHF. Close monitoring with caution is recommended with concurrent lopinavir/ritonavir use. It is not recommended in patients undergoing treatment with fingolimod.
Flecainide or propafenone is a good option for pharmacological cardioversion in patients with no structural heart disease or coronary artery disease who are on fingolimod.
Ibutilide, flecainide, propafenone can be used for cardioversion in patients not treated with fingolimod and without structural heart disease or coronary artery disease.

AADs, anti arrhythmic drugs; AF, atrial fibrillation; CHF, chronic heart failure; COVID-19, coronavirus disease 2019; ECG, electrocardiogram; HF, heart failure.

Modified from Ref.²⁰