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A lung-protective ventilation strategy in COVID-19 patients where renal failure, metabolic acidosis, and hyperkalemia are common may predispose certain patients with myocardial injury to malignant ventricular arrhythmias. Introduction Since December 2019, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has resulted in a pandemic of novel coronavirus (COVID-19) infections. Although predominantly a respiratory illness that can cause acute respiratory distress syndrome (ARDS), data suggest cardiovascular involvement contributes significantly to the disease’s mortality. Data from Wuhan, China, demonstrated patients with pre-existing cardiovascular disease and elevated troponin levels had 69.44% mortality. ARDS is defined by acute hypoxemic respiratory failure of noncardiac etiology, bilateral pulmonary infiltrates, and a decreased PaO2/FIO2 ratio with mortality rates reaching 40%. After decades of ARDS research, little has been described about any associated ventricular arrhythmias despite the potential interplay between pulmonary pathology, treatments, and malignant arrhythmias. Although significant structural heart disease is a risk factor for ventricular arrhythmias, their occurrence in the absence of major cardiac abnormalities requires a full examination of cardiac and noncardiac causes. Furthermore, since respiratory failure is typically associated with pulseless electrical activity (PEA) and asystole rather than ventricular tachycardia (VT) or ventricular fibrillation (VF), the etiology of malignant ventricular arrhythmias in patients without heart disease and a primarily acute pulmonary disease process requires further investigation. We present a series of COVID-19infected patients with preserved cardiac function who developed ARDS and refractory ventricular arrhythmias. To the

heartrhythm case reports

Malignant ventricular arrhythmias in patients with severe acute respiratory distress syndrome due to COVID-19 without significant structural heart disease