Cardiac arrhythmias in patients with SARS-CoV‑2 infection and effects of the lockdown on invasive rhythmological therapy

Abstract

Background Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, various strategies have been taken worldwide to reduce the risk of infection. As part of the amendment to the Infection Protection Act, elective medical interventions were restricted, leading to a change in patient care. However, the consequences of the lockdown on the treatment of rhythmological patients in Germany remains unclear. Objectives The aim of this study was to analyze the reduction in rhythmological interventions and the patient care situation using a nationwide survey during the first lockdown period. Methods A survey was sent to all electrophysiological centers certified by the German Society of Cardiology. Here, the treatment volume of tachycardia and bradycardia and their invasive therapy were surveyed before and during the lockdown period. Furthermore, the number of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) treated at these centers and the incidence of cardiac arrhythmias was also recorded. Results Participating centers performed a total of 24,648 ablation procedures/year and represent approximately 34% (24,648/72,548) of the estimated German ablation treatments. The majority of these centers (33/40; 82.5%) were so-called primary COVID-19 hospitals (level-1). Overall, the number of ablations and pacemaker implantations were reduced by 41% and 18% respectively. Due to postponed ablation procedures and pacemaker implantations, 22/40 (55%) centers reported a worsening of clinical symptoms or early re-hospitalization of their patients. Conclusion These results demonstrate a significant decline in elective rhythmological procedures during the lockdown, as required by the German Federal Government. At the same time, however, more than half of the participating centers reported an increase in patient re-hospitalizations due to postponed procedures.

Impact of the COVID‐19 lockdown in urgent pacemaker implantations: A cross‐sectional study

“…This result reflects the impact of the pandemic on programmed interventions in arrhythmology and strengthens prior reports that the recommendation to limit hospital admissions to the ER, combined with the fear of patients being infected in the hospital, had an impact on urgent/emergent admissions and interventions. The same phenomenon seems to have occurred in other countries that adopted similar measures 6–8 . Compared to the homologous period of 2019, we also noted patients who came to the ER during “lockdown” were significantly more likely to be on statins and had a tendency for being treated more frequently with a RAAS inhibitor.…”

Impact of Nationwide COVID-19 Lockdowns on the Implantation Rate of Cardiac Implantable Electronic Devices

“…Catalonia has reported an overall decrease of 56.5% in pacemaker and ICD implantations during the first wave of COVID-19, affecting both elective and urgent implantations, while a study from England also showed decreases in pacemaker, CRT, and ICD implantations for both elective and urgent indications during the first lockdown [ 8 , 12 ]. Peru reported a decrease of 73% in de novo pacemaker implantations for all aetiologies after the beginning of their first social isolation period, and in Germany a decrease of 18% in pacemaker implantations was recorded during their first lockdown [ 7 , 9 ]. Our study also revealed lower daily rates; however, when comparing the changes using rate ratios, we found more significant changes during the second lockdown compared with the first.…”

“…Other studies have shown that this was also the case in Denmark, even though it has been less severely affected by COVID-19 than Italy [ [3] , [4] , [5] ]. In addition, countries including Greece, Peru, England, and Germany experienced a reduced number of implantations of cardiac implantable electronic devices (CIEDs) during the pandemic [ [6] , [7] , [8] , [9] ].…”