Implantation of cardiac electronic devices in active COVID-19 patients: Results from an international survey

Abstract

Background Cardiac implantable electronic device (CIED) implantation rates, as well as the clinical and procedural characteristics and outcomes in patients with known active COVID-19 are unknown. Objective To gather information regarding CIED procedures during active COVID-19, performed with personal protective equipment, based on an international survey. Methods Fifty-three centers from 13 countries across 4 continents provided information on 166 patients with known active COVID-19 who underwent a CIED procedure. Results CIED procedure rate in 133,655 hospitalized COVID-19 patients ranged from 0 to 16.2 per 1000 patients (p<0.001). Most devices were implanted due to high degree / complete AV block (112, 67.5%) or sick sinus syndrome (31, 18.7%). Of the166 patients surveyed, the 30-day complication rate was 13.9% and the 180-day mortality rate was 9.6%. One patient had a lethal outcome as a direct result of the procedure. Differences in patient and procedural characteristics and outcomes were found between Europe and North America. An older population (76.6 vs. 66 years, p<0.001) with a non-significant higher complication rate (16.5% vs. 7.7%, p=0.2) were observed in Europe, while a higher rate of critically ill patients (3.3% vs. 33.3%, p<0.001) and mortality (5% vs. 26.9%, p=0.002) were observed in North America. Conclusion CIED procedure rates during known active COVID-19 disease varied greatly from 0 to 16.2 per 1000 hospitalized COVID-19 patients worldwide. Patients with active COVID-19 infection who underwent CIED implantation had high complication and mortality rates. Operators should take into consideration these risks prior to proceeding with CIED implantation in active COVID-19 patients.

Impact of COVID-19 Pandemic on Cardiovascular Healthcare in Croatia: A Comprehensive Nationwide Survey

“…At the onset of the pandemic, an increased incidence of bradycardia and relative bradycardia was reported in patients with COVID-19 infection, leading to a rise in pacemaker (PM) implantations [ 26 ]. Among COVID-infected patients, it was observed that most devices were implanted due to high-degree or complete atrioventricular block, with a smaller percentage attributed to sick sinus syndrome (SSS) [ 27 ]. However, a pan-European observational registry across 15 centers from 12 countries revealed a relative decrease in the percentage of bradycardia/atrioventricular blocks (AVB) in acute cardiac settings from 14% in 2019 to 11% in 2020 [ 4 ].…”

Contributions of Israel to the field of clinical cardiac electrophysiology and implantable devices

“…Tovia-Brodie et al 206 reported the results of an international survey dealing with implantation of CIEDs in patients with active coronavirus disease 2019, showing that patients with active coronavirus disease 2019 who underwent CIED implantation had high complication and mortality rates.…”

Long-term cardiac surveillance and outcomes of COVID-19 patients

“…While bradyarrhythmias may be transient in some, other patients have required implantation of a cardiac implantable electrical device (CIED). Among patients hospitalized with COVID-19, one study, utilizing surveys, identified a crude rate of CIED implant of 1.16 per 100,000 hospitalized patients [61] . The predominant indications for CIED were high degree AV block (65%), sick sinus syndrome (21%), device generator change (4.2%), and secondary prevention for sudden death (4.8%).…”