Electrophysiology in the time of coronavirus: coping with the great wave

Abstract

Aims: To chart the effect of the COVID-19 pandemic on the activity of interventional electrophysiology services in affected regions. Methods: We reviewed the electrophysiology laboratory records in 3 affected cities: Wenzhou in China, Milan in Italy and London, United Kingdom. We interviewed electrophysiologists in each centre to gather information on the impact of the pandemic on working patterns and on the health of staff members. Results: There was a striking decline in interventional electrophysiology activity in each of the centres. The decline occurred within a week of the recognition of widespread community transmission of the virus in each region and shows a striking correlation with the national figures for new diagnoses of COVID-19 in each case. During the period of restriction, work-flow dropped to <5% of normal, consisting of emergency cases only. In 2 of 3 centres, electrophysiologists were redeployed to perform emergency work outside electrophysiology. Among the centres studied, only Wenzhou has seen a recovery from the restrictions in activity. Following an intense nationwide program of public health interventions, local transmission of COVID-19 ceased to be detectable after February 18th allowing the electrophysiology service to resume with a strict testing regime for all patients. Conclusion: Interventional electrophysiology is vulnerable to closure in times of great social difficulty including the COVID-19 pandemic. Intense public health intervention can permit suppression of local disease transmission allowing resumption of some normal activity.

Impact of the COVID-19 pandemic on atrial fibrillation and atrial flutter ablation rates. The analysis of nearly 5 million Polish population

“…Additionally, patients eligible for ablation were older, mostly male, and presented with comorbidities (such as diabetes, hypertension or heart failure), which increased the risk for an unfavorable course of infection [8,10]. These data are consistent with our observations.…”

“…The impact of the COVID-19 pandemic on the number of electrophysiological procedures varied across countries and regions, depending on the availability of hospital beds or necessary changes in healthcare management. Li et al [8] found a significant decrease in the number of electrophysiological procedures performed in various countries, which was related to the time of occurrence of the first wave of the disease. Based on Italian data, Boriani et al…”

“…Based on the previously published data, a large reduction in elective procedures could be noticed. However, urgent procedures such as electrical storm ablation or treatment of arrhythmias, including AF, causing hemodynamic instability, were treated with adequate prophylaxis without undue delay, regardless of the result of the SARS-CoV-2 test [8,10].…”

The survey of electrophysiology lab activity during the COVID‐19 pandemic

“…However, with the prolongation of the pandemic and increasing recognition of the nonpulmonary complications of COVID‐19, such as cardiovascular disease, the need to return all health services of hospitals was felt. Among these, cardiac electrophysiological studies (EPSs) and implantation of intracardiac devices were significantly decreased during the COVID‐19 era; however, increased incidence of cardiac arrhythmias in COVID‐19‐infected patients, greater incidence of ischemic (because of delay for appropriate treatment) and nonischemic cardiomyopathies, and economic and social stress arising from quarantine rules are reasons why these procedures are necessary 5‐8 …”

Effects of Covid-19 Lockdown on Patients with Implantable Cardioverter-Defibrillators in South of Italy: possible causes?

“…The effects of lockdown period were explored in different contexts and terms: eating habits and lifestyle changes, 10 approaches implemented to support teleconsultations and management of AF and heart failure patients. 11,12 new-onset of arrhythmic events such as atrial fibrillation, 3 impact on interventional electrophysiology units routine and emergency work, 13 .…”