Guidance for rebooting electrophysiology through the COVID-19 pandemic from the Heart Rhythm Society and the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology

Abstract

Coronavirus disease 2019 (COVID-19) has presented substantial challenges to patient care and impacted health care delivery, including cardiac electrophysiology practice throughout the globe. Based upon the undetermined course and regional variability of the pandemic, there is uncertainty as to how and when to resume and deliver electrophysiology services for arrhythmia patients. This joint document from representatives of the Heart Rhythm Society, American Heart Association, and American College of Cardiology seeks to provide guidance for clinicians and institutions reestablishing safe electrophysiological care. To achieve this aim, we address regional and local COVID-19 disease status, the role of viral screening and serologic testing, return-to-work considerations for exposed or infected health care workers, risk stratification and management strategies based on COVID-19 disease burden, institutional preparedness for resumption of elective procedures, patient preparation and communication, prioritization of procedures, and development of outpatient and periprocedural care pathways.

Hospitalization deficit of in‐ and outpatient cases with cardiovascular diseases and utilization of cardiological interventions during the COVID‐19 pandemic: Insights from the German‐wide helios hospital network

“…A similar or even pronounced reduction of cardiac catheterizations and electrophysiological interventions was reported from a nationwide database of the UK 30 . Studies on the number of catheter ablations during the COVID‐19 pandemic are missing for continental Europe, but recommendations from scientific societies to reduce planned procedures should also be the most important influencing factors here, especially because the majority of electrophysiological interventions are elective in nature 28,31 . An early report from Italy showed a significant reduction in urgent pacemaker implantation rates (−28%) compared with 2019 without differences in the composition of the cohort regarding age or presentation with total AV block or syncope 13 .…”

Prospective implementation of a same-day discharge protocol for catheter ablation of paroxysmal atrial fibrillation

“…During the current COVID-19 pandemic, several publications are providing guidance for clinicians and institutions to rebuild safe electrophysiological care [13][14][15]. A joint guidance from the Heart Rhythm Society, the American Heart Association, and a committee within the American College of Cardiology recommends consideration of same-day discharge, as clinically appropriate, to minimize patient exposure [13]. The current study may provide a helpful guide by establishing well-defined criteria for preemptive identification of low-risk patients that can be safely discharged the same day, thus reducing their potential for exposure to COVID-19.…”

Rebooting atrial fibrillation ablation in the COVID-19 pandemic

“…Meeting the challenges of peak COVID-19 infection resulted in reassignment of hospital beds and repurposing of personnel throughout the USA. Electrophysiology programs like ours, in accordance with recommendations collectively provided by professional societies [1,2] and local regulations, prioritized urgent electrophysiological procedures during periods of high healthcare utilization related to COVID-19 [3]. These efforts have helped to minimize patient and healthcare professional exposure by postponement of elective cases and careful management of urgent or otherwise time-sensitive conditions.…”

“…Coronavirus disease 2019 (COVID-19) resulted in curtailment of non-emergent medical care in order to limit exposure to patients and healthcare workers and preserve limited personal protective equipment (PPE) [1]. Meeting the challenges of peak COVID-19 infection resulted in reassignment of hospital beds and repurposing of personnel throughout the USA.…”