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. 2024 Jan;19(1):107-114.
doi: 10.1007/s11739-023-03450-1. Epub 2023 Nov 7.

A global analysis of implants and replacements of pacemakers and cardioverter-defibrillators before, during, and after the COVID-19 pandemic in Italy

Massimo Zecchin #  1 , Enrico Ciminello #  2 , Veronica Mari  2 , Alessandro Proclemer  3 , Antonio D'Onofrio  4 , Gabriele Zanotto  5 , Roberto De Ponti  6 , Teresa Maria Capovilla  1 , Paola Laricchiuta  2 , Alessia Biondi  2 , Letizia Sampaolo  2 , Simona Pascucci  2 , Gianfranco Sinagra  1 , Giuseppe Boriani  7 , Eugenio Carrani  2 , Marina Torre  2
Affiliations

A global analysis of implants and replacements of pacemakers and cardioverter-defibrillators before, during, and after the COVID-19 pandemic in Italy

Massimo Zecchin et al. Intern Emerg Med. 2024 Jan.

Abstract

At the beginning of the COVID-19 emergency, non-urgent surgical procedures had to be deferred, but also emergencies were reduced. To assess the global trend of pacemaker (PM) and implantable cardiac-defibrillator (ICD) procedures performed in Italy before, during, and after the first COVID-19 emergency, all the Italian hospital discharge records related to PM/ICD procedures performed between 2012 and 2021, sent to the National Institute of Health, were reviewed. Compared to 2019, in 2020, there was a reduction of first PM implants (52,216 to 43,962, -16%; p < 0.01), but not replacements (16,591 to 17,331, + 4%; p = 0.16). In particular, in April 2020, there was a drop of first implants (- 53,4% vs the average value of April 2018 and April 2019; p < 0.01), while the reduction of replacements was less evident (-32.6%; p = NS). In 2021, PM procedures increased to values similar to the pre-pandemic period. A reduction of ICD procedures was observed in 2020 (22,355, -7% toward 2019), mainly in April 2020 (- 46% vs April 2018/April 2019; p = 0.03). In 2021, the rate of ICD procedures increased (+ 14% toward 2020). A non-significant reduction of "urgent" procedures (complete atrioventricular block for PM and ventricular fibrillation for ICD), even in April 2020, was observed. In 2020, there was a reduction of first PM implants and ICDs, offset by increased activity in 2021. No decrease in PM replacements was observed, and the drop in "urgent" PM and ICD procedures was not statistically significant.

Keywords: COVID-19 pandemic; Hospital discharge records; Implantable cardioverter-defibrillator; Lockdown; Pacemaker; Replacement.

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Conflict of interest statement

MZ has received speaker honoraria and financial support for attending symposia from Biotronik. RDP received honoraria from Biosense Webster and Medtronic for lectures and scientific collaboration. GS has received honoraria for speaking at symposia from Novartis, Bayer, Astrazeneca, Boston Scientific, Vifor Pharma, Menarini, Akcea Therapeutics, Alfasigma and for consultation from Novartis, Impulse Dynamics, Biotronik. GB received speaker’s fees of small amount form Bayer, Boston Scientific, Daiichi-Sankyo, Janssen, Sanofi, outside the submitted work.

Figures

Fig. 1
Fig. 1
Total number of PM and implantable cardiac-defibrillator procedures per year from 2001 to 2021 in Italy. PM, pacemaker; ICD, implantable cardiac-defibrillator
Fig. 2
Fig. 2
Total number of PM and ICD procedures per month from January 2018 to December 2021 in Italy. PM, pacemaker; ICD, implantable cardiac-defibrillator
Fig. 3
Fig. 3
Number of first pacemaker implants and replacements per month from January 2018 to December 2021 in Italy. PM, pacemaker
Fig. 4
Fig. 4
Total number of CRT-D and ICD non-CRT implants per month from January 2018 to December 2021 in Italy. CRT-D, cardiac resynchronization therapy defibrillator; ICD, implantable cardiac-defibrillator
See this image and copyright information in PMC

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