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. 2023 Jan;18(1):137-149.
doi: 10.1007/s11739-022-03140-4. Epub 2022 Nov 9.

Five waves of COVID-19 pandemic in Italy: results of a national survey evaluating the impact on activities related to arrhythmias, pacing, and electrophysiology promoted by AIAC (Italian Association of Arrhythmology and Cardiac Pacing)

Giuseppe Boriani  1 , Federico Guerra  2 , Roberto De Ponti  3 , Antonio D'Onofrio  4 , Michele Accogli  5 , Matteo Bertini  6 , Giovanni Bisignani  7 , Giovanni Battista Forleo  8 , Maurizio Landolina  9 , Carlo Lavalle  10 , Pasquale Notarstefano  11 , Renato Pietro Ricci  12 , Gabriele Zanotto  13 , Pietro Palmisano  5 ; for AIAC Ricerca Network Investigators
Collaborators, Affiliations

Five waves of COVID-19 pandemic in Italy: results of a national survey evaluating the impact on activities related to arrhythmias, pacing, and electrophysiology promoted by AIAC (Italian Association of Arrhythmology and Cardiac Pacing)

Giuseppe Boriani et al. Intern Emerg Med. 2023 Jan.

Abstract

Background: The subsequent waves of the COVID-19 pandemic in Italy had a major impact on cardiac care.

Methods: A survey to evaluate the dynamic changes in arrhythmia care during the first five waves of COVID-19 in Italy (first: March-May 2020; second: October 2020-January 2021; third: February-May 2021; fourth: June-October 2021; fifth: November 2021-February 2022) was launched.

Results: A total of 127 physicians from arrhythmia centers (34% of Italian centers) took part in the survey. As compared to 2019, a reduction in 40% of elective pacemaker (PM), defibrillators (ICD), and cardiac resynchronization devices (CRT) implantations, with a 70% reduction for ablations, was reported during the first wave, with a progressive and gradual return to pre-pandemic volumes, generally during the third-fourth waves, slower for ablations. For emergency procedures (PM, ICD, CRT, and ablations), recovery from the initial 10% decline occurred in most cases during the second wave, with some variability. However, acute care for atrial fibrillation, electrical cardioversions, and evaluations for syncope showed a prolonged reduction of activity. The number of patients with devices which started remote monitoring increased by 40% during the first wave, but then the adoption of remote monitoring declined.

Conclusions: The dramatic and profound derangement in arrhythmia management that characterized the first wave of the COVID-19 pandemic was followed by a progressive return to the volume of activities of the pre-pandemic periods, even if with different temporal dynamics and some heterogeneity. Remote monitoring was largely implemented during the first wave, but full implementation is needed.

Keywords: Ablation; Arrhythmia; Atrial fibrillation; COVID-19; Cardiac resynchronization therapy; Implantable cardioverter defibrillators; Pacemakers; Remote monitoring.

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Conflict of interest statement

G Boriani: small speaker fees from Bayer, Boston, Boehringer Ingelheim, and Daiichi-Sankyo. F Guerra: small speaker fees from Bayer, Bristol-Meyers-Squibb, Boston, Boehringer-Ingelheim, Daiichi-Sankyo, and Zoll. M Bertini: small speaker fees from Boston Scientific, Abbott, Boehringer Ingelheim, and Bayer. M Landolina: modest speaker fees from Bayer, Boehringer Ingelheim, Boston Scientific, LivaNova, Medtronic, and Pfizer. RP Ricci: small speaker fees by Boston e Biotronik; advisory board modest fees by Dompé. R De Ponti: lecture fees from Biosense Webster and Biotronik. P Palmisano: small speaker fees from Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Medtronic. Novartis and personal fees from Proctorship agreement with Abbott, Medtronic, Biotronik, and Boston Scientific. No conflicts of interest were reported by the other authors.

Figures

Fig. 1
Fig. 1
The first five waves of the COVID-19 pandemic as observed in Italy. *Data from Italian Civil Protection Department [15]
Fig. 2
Fig. 2
Number of operators per center (A); rate of centers with at least one operator and with > 50% of operators directly involved in the management of patients with COVID-19 during the first five waves of COVID-19 pandemic (B); the number of CIEDs implantations (C) and of elective ablations (D) performed per year at the participating centers. CIEDs: cardiac implantable electronic devices
Fig. 3
Fig. 3
Variations in the number of elective PM implantations (A), ICD implantations for primary prevention (B), CRT device implantations (C), and elective ablation procedures (D) during the first five waves of the COVID-19 pandemic compared to the same periods of 2019. The box and whiskers graphs show median, 25th and 75th percentiles, and extreme values. *P < 0.05 compared to CIEDs implantations in emergency setting (see Fig. 4). §P < 0.05 compared to ablations performed in emergency setting (see Fig. 4). ANOVA, analysis of variance; CIED, cardiac implantable electronic device; CRT, cardiac resynchronization therapy; ICD, implantable cardioverter-defibrillator; PM, pacemaker
Fig. 4
Fig. 4
Variations in the number of ICD implantations for secondary prevention (A), CIEDs implantations in the emergency setting (B), ablation performed in the emergency setting (C), and cases requiring acute treatment of AF in the emergency setting (D) during the first five waves of COVID-19 pandemic compared to the same periods of 2019. The box and whiskers graphs show median, 25th and 75th percentiles, and extreme values. *P < 0.05 compared to elective PM implantations (see Fig. 3). §P < 0.05 compared to elective ablation procedures (see Fig. 3). AF, atrial fibrillation; ANOVA, analysis of variance; CIED, cardiac implantable electronic device; ICD, implantable cardioverter-defibrillator; PM, pacemaker
Fig. 5
Fig. 5
Variations in the number of elective direct-current cardioversions of persistent AF/atrial flutter performed under day-case admission (A), elective evaluations of patients with syncope (B), new CIED patients enrolled in the remote monitoring program (C) during the first five waves of COVID-19 pandemic compared to the same periods of 2019. The box and whiskers graphs show median, 25th and 75th percentiles, and extreme values. AF, atrial fibrillation; ANOVA, analysis of variance; CIED, cardiac implantable electronic device
See this image and copyright information in PMC

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