Rebooting atrial fibrillation ablation in the COVID-19 pandemic

Barbhaiya, Chirag R.; Wadhwani, Lalit; Manmadhan, Arun; Selim, Ahmed M.; Kushnir, Alexander; Spinelli, Michael; Jankelson, Lior; Bernstein, Scott; Park, David; Holmes, Douglas; Aizer, Anthony; Chinitz, Larry A.

doi:10.1007/s10840-021-00952-w

Cited by 7 publications

(5 citation statements)

References 10 publications

(9 reference statements)

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“…Six (26.1%) studies reported an inverse relationship between rising COVID-19 cases and the declining rates of EP procedures 11 , 17 – 20 , 27 . Organizational restructuring in response to the pandemic and the issuance of new guidelines for EP procedures were reported in nine (39.1%) studies 4 , 10 , 14 – 17 , 19 , 29 , 30 .…”

Section: Resultsmentioning

confidence: 99%

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Effect of COVID-19 on cardiac electrophysiology practice: a systematic review of literature

Almas

Ehtesham

Khan

et al. 2023

Annals of Medicine &Amp; Surgery

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The authors conducted a systematic review on the effect of coronavirus disease 2019 on electrophysiology (EP) practice and procedure volume in various settings. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. PubMed/MEDLINE, Scopus, Web of Science, CINAHL, and Embase were examined with combinations of medical subject headings terms for identification of the relevant studies. After excluding duplicates, irrelevant, and ineligible studies, 23 studies were included for full qualitative analysis. The overall study-level volume reduction of EP procedures ranged from 8 to 96.7%. All studies reported an overall reduction in EP physiology procedures being carried out except one in Poland, which reported an overall increase in the total EP procedures carried out in 2020. This study still reported a decrease in EP procedure volume during the first lockdown phase. Procedural volume reduction was seen most commonly for cardiovascular implantable electronic device placement (20/23 studies, 86.9%), electrophysiology studies (11/23 studies, 47.8%), and ablations (9/23, 39.1% studies). The most common reason stated for the observed decline in EP procedures was the cancellation and postponement of nonurgent elective cases in the hospitals (15/23 studies, 65.2%). There has been an overall reduction in EP procedure volume across different centers. The impact of the decline in EP procedures will be seen only after the services resume to prepandemic levels, but an increase in-patient volume and procedure waiting time is expected. This review will provide insights into improving healthcare service delivery in times of unprecedented public health emergencies.

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Section: Resultsmentioning

confidence: 99%

“…Strict adherence to COVID-19 protocols can prevent postprocedural COVID-19 infections in both patients and staff amidst marked local COVID-19 prevalence. The practice of postprocedural same-day discharge wherever possible and virtual follow-up decreases the duration of hospital stays and provides adequate care to patients 30 .…”

Section: Discussionmentioning

confidence: 99%

Effect of COVID-19 on cardiac electrophysiology practice: a systematic review of literature

Almas

Ehtesham

Khan

et al. 2023

Annals of Medicine &Amp; Surgery

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“…Comparison of preoperative practices (transesophageal echocardiography) and acute procedural outcomes of catheter ablation during and before COVID-19 pandemic revealed lesser rate of COVID-19 transmission, reduced complication rate and higher same day discharges in the 2020 cohort compared to 2019 cohort. These findings emphasize that complex electrophysiological procedures can be safety administered to high-risk COVID-19 patients with atrial fibrillation results in optimal clinical outcomes while maintaining the quality of care [ 67 ]. Analysis of 269 patients who underwent catheter ablation for arrhythmia in COVID-19 patients from January 1, 2020, to March 24, 2020, revealed arrhythmia-free survival in 95.9% patients, no COVID-19 infections reported during brief hospitalization period (3–5 days), and no COVID-19 infections during 3-month follow-up [ 68 ].…”

Section: Main Textmentioning

confidence: 99%

COVID-19 HEART unveiling as atrial fibrillation: pathophysiology, management and future directions for research

2023

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Background COVID-19 infections are known to cause numerous systemic complications including cardiovascular disorders. In this regard, clinicians recently noticed that patients recovering from COVID-19 infections presented with diverse set of cardiovascular disorders in addition to those admitted to ICU (intensive care unit). COVID-19 heart has multifaceted presentation ranging from dysrhythmias, myocarditis, stroke, coronary artery disease, thromboembolism to heart failure. Atrial fibrillation is the most common cardiac arrhythmia among COVID-19 patients. In the background section, we briefly discussed epidemiology and spectrum of cardiac arrhythmias in COVID-19 patients. Main body In this state-of-the-art review we present here, we present the information regarding COVID-19-induced A-fib in sections, namely mechanism of action, clinical presentation, diagnosis and treatment. Unfortunately, its occurrence significantly increases the mortality and morbidity with a potential risk of complications such as cardiac arrest and sudden death. We included separate sections on complications including thromboembolism and ventricular arrhythmias. Since its mechanism is currently a gray area, we included a separate section on basic science research studies that are warranted in the future to comprehend its underlying pathogenic mechanisms. Conclusions Taken together, this review builds upon the current literature of COVID-19-induced A-fib, including pathophysiology, clinical presentation, treatment and complications. Furthermore, it provides recommendations for future research moving forward that can open avenues for developing novel remedies that can prevent as well as hasten clinical recovery of atrial fibrillation in COVID-19 patients.

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“…Increased utilization of catheter ablation in recent years and decreased procedural volumes during the COVID-19 pandemic further motivated this work. 14–16 Moreover, the consequences of such delays in catheter ablation for AF patients in terms of adverse events during the wait-period have not been studied.…”

Section: Introductionmentioning

confidence: 99%

Variation and clinical consequences of wait-times for atrial fibrillation ablation: population level study in Ontario, Canada

Qeska

Singh

Qiu³

et al. 2023

Europace

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Aims Atrial fibrillation (AF) is the most common cardiac rhythm disorder. Emerging evidence supporting the efficacy of catheter ablation in managing AF has led to increased demand for this therapy, potentially outpacing the capacity to perform this procedure. Mismatch between demand and capacity for AF ablation results in wait-times which have not been comprehensively evaluated at a population level. Additionally, the consequences of such delays in AF ablation, namely the risk of hospitalization or adverse events, have not been studied. Methods and results This observational cohort study included adults referred for catheter ablation to treat AF in Ontario, Canada, between 1 April 2016 and 31 March 2020. Wait-time was defined from referral to the earliest of ablation, death, off-list, or the study endpoint of 31 March 2022. The outcomes of interest included a composite of death, hospitalization for AF/heart failure, and emergency department visit for AF/heart failure. Our study cohort included 6253 patients referred for de novo AF ablation. The median wait-time for patients who received and who did not receive ablation was 218 days (IQR: 112–363) and 520 days (IQR: 270–763), respectively. Wait-time increased consistently for patients referred between October 2017 and March 2020. Mortality was rare, but significant morbidity was observed, affecting 19.2% of patients on the waitlist for AF ablation. Paroxysmal AF was associated with a statistically significant greater risk for adverse outcomes on the waitlist (HR 1.51, 95% CI 1.18–1.93). Conclusion Wait-times for AF ablation are increasing and are associated with significant morbidity.

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Rebooting atrial fibrillation ablation in the COVID-19 pandemic

Cited by 7 publications

References 10 publications

Effect of COVID-19 on cardiac electrophysiology practice: a systematic review of literature

Effect of COVID-19 on cardiac electrophysiology practice: a systematic review of literature

COVID-19 HEART unveiling as atrial fibrillation: pathophysiology, management and future directions for research

Variation and clinical consequences of wait-times for atrial fibrillation ablation: population level study in Ontario, Canada

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