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García-Fernández FJ, Calvo Simal S, Cano Pérez Ó, Calvo Cuervo D, Pombo Jiménez M, Fernández Lozano I, Villagraz Tercedor L, Fernández Palacios G, Martín González J. Impact of the COVID-19 pandemic on implantation of cardiac implantable electronic devices and remote monitoring activations. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:243-253. [PMID: 37516312 DOI: 10.1016/j.rec.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/07/2023] [Indexed: 07/31/2023]
Abstract
INTRODUCTION AND OBJECTIVES Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) is considered more reliable, efficient, and safer than conventional in-person follow-up. However, the implementation of RM is still suboptimal. This study aimed to analyze the impact of the COVID-19 pandemic on the rates of CIED implants and RM activations in Spain. METHODS The COVID-19 RM Spain Registry was used to analyze the monthly number of all CIED implantations and RM activations from January 2018 to December 2021. A descriptive analysis was performed using aggregated data from the five major CIED manufacturers. RESULTS A total of 205 345 CIEDs were recorded. The number of implants decreased sharply (48.2%) during the pandemic lockdown (March-June 2020) but gradually increased thereafter, compensating for the previous reduction. However, pacemakers and implantable cardiac defibrillators (ICD) showed an aggregate loss of 7% and 3%, respectively, from the annual average during 2020-2021. In contrast, cardiac resynchronization therapy defibrillators (CRT-D) increased by 17%, and pacemakers (CRT-P) by 4.5% over the 2-year period. The percentage of RM activations increased from 24.5% in 2018 to 49.0% in 2021, with a sharp increase during the lockdown. The RM activation rates consistently increased during the lockdown for all devices: pacemakers (14.4% vs 37.2%; P <.001); ICD (75.6% vs 94.2%; P <.001); CRT-D/CRT-P (68.6-44.2% vs 81.6-61%; P <.001), and implantable loop recorders (50.2% vs 68.7%; P <.001). CONCLUSIONS The significant decline in implants during the lockdown gradually recovered, except for pacemakers and ICD. However, the COVID-19 pandemic boosted RM for all CIEDs in Spain.
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Affiliation(s)
- F J García-Fernández
- Unidad de Arritmias, Servicio de Cardiología., Hospital Universitario de Burgos, Burgos, Spain.
| | - Sara Calvo Simal
- Unidad de Investigación, Fundación Burgos por las Ciencias de la Salud, Universidad de Burgos, Burgos, Spain
| | - Óscar Cano Pérez
- Unidad de Arritmias, área de Enfermedades Cardiovasculares, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - David Calvo Cuervo
- Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | - Marta Pombo Jiménez
- Unidad de Arritmias, Servicio de Cardiología, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - Ignacio Fernández Lozano
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Lola Villagraz Tercedor
- Unidad de Arritmias, Servicio de Cardiología., Hospital Universitario de Burgos, Burgos, Spain
| | | | - Javier Martín González
- Unidad de Arritmias, Servicio de Cardiología., Hospital Universitario de Burgos, Burgos, Spain
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2
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Texiwala SZ, de Souza RJ, Turner S, Singh SM. Physical Activity, Heart Rate Variability, and Ventricular Arrhythmia During the COVID-19 Lockdown: Retrospective Cohort Study. JMIR Cardio 2024; 8:e51399. [PMID: 38315512 PMCID: PMC10877486 DOI: 10.2196/51399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/18/2023] [Accepted: 12/26/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Ventricular arrhythmias (VAs) increase with stress and national disasters. Prior research has reported that VA did not increase during the onset of the COVID-19 lockdown in March 2020, and the mechanism for this is unknown. OBJECTIVE This study aimed to report the presence of VA and changes in 2 factors associated with VA (physical activity and heart rate variability [HRV]) at the onset of COVID-19 lockdown measures in Ontario, Canada. METHODS Patients with implantable cardioverter defibrillator (ICD) followed at a regional cardiac center in Ontario, Canada with data available for both HRV and physical activity between March 1 and 31, 2020, were included. HRV, physical activity, and the presence of VA were determined during the pre- (March 1-10, 2020) and immediate postlockdown (March 11-31) period. When available, these data were determined for the same period in 2019. RESULTS In total, 68 patients had complete data for 2020, and 40 patients had complete data for 2019. Three (7.5%) patients had VA in March 2019, whereas none had VA in March 2020 (P=.048). Physical activity was reduced during the postlockdown period (mean 2.3, SD 1.6 hours vs mean 2.1, SD 1.6 hours; P=.003). HRV was unchanged during the pre- and postlockdown period (mean 91, SD 30 ms vs mean 92, SD 28 ms; P=.84). CONCLUSIONS VA was infrequent during the COVID-19 pandemic. A reduction in physical activity with lockdown maneuvers may explain this observation.
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Affiliation(s)
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON, Canada
| | - Suzette Turner
- Schulich Heart Center, Sunnybrook Health Sciences, Toronto, ON, Canada
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, ON, Canada
| | - Sheldon M Singh
- Schulich Heart Center, Sunnybrook Health Sciences, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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3
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Ali S, Khanal R, Najam M, Fakhra S, Manasrah N, Keisham B, Farooq F, Duhan S, Sattar Y, Changezi H, Alraies MC. Short-Term Outcomes of Cardiac Arrhythmias Among COVID-19 Patients: A Propensity Matched National Study. Curr Probl Cardiol 2024; 49:102087. [PMID: 37716538 DOI: 10.1016/j.cpcardiol.2023.102087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/18/2023]
Abstract
The risk of arrhythmia is high in patients with COVID-19. The current literature is limited in understanding the clinical impact of arrhythmias and the extent of healthcare utilization in COVID-19 patients. The Nationwide In-patient Sample Database (NIS) from 2019 to 2020 was queried to identify COVID-19 patients who developed arrhythmias vs those without. Multivariate regression for adjusted odds ratios (aOR) and propensity score matching (PSM) were done to compare outcomes among both cohorts. A total of 1,664,240 patients (weighted) were hospitalized with COVID-19 infection, 380,915 (22.89%) of whom were diagnosed with an arrhythmia. After propensity matching COVID-19 with arrhythmias had higher rates of in-hospital mortality (22.4% vs 13.5%, P < 0.001), acute kidney injury (PSM 39.4% vs 35.7%, P < 0.001), acute heart failure (AHF) (18.2% vs 12.6%, P < 0.001), acute stroke (0.76% vs 0.57%, P < 0.001), cardiogenic shock (1.38% vs 0.5%, P < 0.001), cardiac arrest (5.26% vs 2.3%, P < 0.001) acute myocardial infarction (AMI) (12.8% vs 7.8%, P < 0.001), intracerebral hemorrhage (0.63% vs 0.45%, P < 0.001), major bleeding (2.6% vs 1.8%, P < 0.001) and endotracheal intubation (17.04% vs 10.17% < 0.001) compared to arrhythmias without COVID-19. This cohort also had lower odds of receiving interventions such as cardiac pacing (aOR 0.15 95% Cl 0.13-0.189 P < 0.001), cardioversion (aOR 0.43 95% CI 0.40-0.46, P < 0.001), and defibrillator (aOR 0.087 95% Cl 0.061-0.124, P < 0.001) compared to arrhythmia patients without COVID-19. Cardiac arrhythmias associated with COVID-19 resulted in longer length of hospital stay and higher total costs of hospitalizations. Arrhythmias associated with COVID-19 had worse clinical outcomes with an increased rate of in-hospital mortality, longer length of hospital stay, and higher total cost. These patients also had lower odds of receiving interventions during the index hospitalization.
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Affiliation(s)
- Shafaqat Ali
- Department of Internal Medicine, Louisiana State University, Shreveport, LA
| | - Resha Khanal
- Department of Internal Medicine, Promedica Physician Group, Toledo, OH
| | - Maria Najam
- Department of Internal Medicine, University of Texas Rio Grande Valley, TX
| | - Sadaf Fakhra
- University of Nevada, Las Vegas-Kirk Kerkorian School of Medicine, NV
| | | | - Bijeta Keisham
- Department of Internal Medicine, Sinai Hospital of Baltimore, MD
| | - Faryal Farooq
- Department of Internal Medicine, Allama Iqbal Medical College Lahore, Punjab, Pakistan
| | - Sanchit Duhan
- Department of Internal Medicine, Sinai Hospital of Baltimore, MD
| | - Yasar Sattar
- Department of Cardiology, West Virginia University, Morgantown, WV
| | - Hameem Changezi
- Department of Cardiology, Mclaren Healthcare Corp, Flint, MI
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4
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Foltran D, Guilbeau-Frugier C, Marimpouy N, Beneyto M, Cherbi M, Bongard V, Maury P. Lack of temporal correlations between COVID pandemic waves and the occurrence of malignant ventricular arrhythmias. Europace 2023; 25:euad357. [PMID: 38051977 PMCID: PMC10751852 DOI: 10.1093/europace/euad357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 12/07/2023] Open
Abstract
AIMS Correlations between malignant ventricular arrhythmias and the COVID waves have never been investigated. METHODS AND RESULTS Prevalence of malignant ventricular arrhythmias/sudden cardiac death has been correlated to the four COVID waves between the onset of pandemic and end 2021. No significant correlation was present in the temporal evolution of both COVID patients/positive tests and incidence of malignant ventricular arrhythmias, which tended to decrease after vaccination onset. CONCLUSION We present evidence of complex higher-order periodicities and the co-existence of such regions with stable non-chaotic areas in ex vivo human hearts. We infer that the oscillation of the calcium cycling machinery is the primary mechanism of higher-order dynamics. These higher-order regions may act as niduses of instability and may provide targets for substrate-based ablation of VF.
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Affiliation(s)
- Deborah Foltran
- Cardiology, University Hospital Toulouse, 1, avenue du Pr Jean Poulhès - TSA 50032- 31059 Toulouse cedex 9, France
| | - Céline Guilbeau-Frugier
- Cardiology, University Hospital Toulouse, 1, avenue du Pr Jean Poulhès - TSA 50032- 31059 Toulouse cedex 9, France
| | - Nathan Marimpouy
- Cardiology, University Hospital Toulouse, 1, avenue du Pr Jean Poulhès - TSA 50032- 31059 Toulouse cedex 9, France
| | - Maxime Beneyto
- Cardiology, University Hospital Toulouse, 1, avenue du Pr Jean Poulhès - TSA 50032- 31059 Toulouse cedex 9, France
| | - Miloud Cherbi
- Cardiology, University Hospital Toulouse, 1, avenue du Pr Jean Poulhès - TSA 50032- 31059 Toulouse cedex 9, France
| | - Vanina Bongard
- Cardiology, University Hospital Toulouse, 1, avenue du Pr Jean Poulhès - TSA 50032- 31059 Toulouse cedex 9, France
| | - Philippe Maury
- Cardiology, University Hospital Toulouse, 1, avenue du Pr Jean Poulhès - TSA 50032- 31059 Toulouse cedex 9, France
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5
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Rath B, Doldi F, Willy K, Ellermann C, Köbe J, Güner F, Reinke F, Lange PS, Frommeyer G, Eckardt L. Ventricular arrhythmia burden in ICD patients during the second wave of the COVID-19 pandemic. Clin Res Cardiol 2023:10.1007/s00392-023-02320-2. [PMID: 37902845 DOI: 10.1007/s00392-023-02320-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 10/09/2023] [Indexed: 11/01/2023]
Abstract
AIM COVID-19 has been associated with cardiovascular complications including ventricular arrhythmias (VA) and an increased number of out-of-hospital cardiac arrests. Nevertheless, several authors described a decrease of VA burden in patients with an implantable defibrillator (ICD) during the first wave of the COVID-19 pandemic. The objective of this study was to determine if these observations could be transferred to later periods of the pandemic as well. METHODS We retrospectively analyzed a total of 1674 patients with an ICD presenting in our outpatient clinic during the second wave of the COVID-19 pandemic and during a control period for the occurrence of VA requiring ICD interventions. RESULTS Seven hundred ninety-five patients with an ICD had a device interrogation in our ambulatory clinic during the second wave of the COVID-19 pandemic compared to eight hundred seventy-nine patients in the control period. There was significant higher amount of adequate ICD therapies in the course of the COVID-19 period. Thirty-six patients (4.5%) received in total eighty-five appropriate ICD interventions during COVID-19, whereas only sixteen patients (1.8%) had sustained VA in the control period (p = 0.01). CONCLUSION In contrast to the first wave of COVID-19, which was characterized by a decrease or least stable number of ICD therapies in several centers, we found a significant increase of VA in ICD patients during the second wave of COVID-19. Possible explanations for this observation include higher infectious rates, potential cardiac side effects of the vaccination as well as personal behavioral changes, or reduced utilization of medical services.
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Affiliation(s)
- Benjamin Rath
- Department of Cardiology II-Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
| | - Florian Doldi
- Department of Cardiology II-Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Kevin Willy
- Department of Cardiology II-Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Christian Ellermann
- Department of Cardiology II-Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Julia Köbe
- Department of Cardiology II-Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Fatih Güner
- Department of Cardiology II-Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Florian Reinke
- Department of Cardiology II-Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Philipp Sebastian Lange
- Department of Cardiology II-Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Gerrit Frommeyer
- Department of Cardiology II-Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Lars Eckardt
- Department of Cardiology II-Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
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6
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Cosentino F, Verma S, Ambery P, Treppendahl MB, van Eickels M, Anker SD, Cecchini M, Fioretto P, Groop PH, Hess D, Khunti K, Lam CSP, Richard-Lordereau I, Lund LH, McGreavy P, Newsome PN, Sattar N, Solomon S, Weidinger F, Zannad F, Zeiher A. Cardiometabolic risk management: insights from a European Society of Cardiology Cardiovascular Round Table. Eur Heart J 2023; 44:4141-4156. [PMID: 37448181 DOI: 10.1093/eurheartj/ehad445] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/24/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Metabolic comorbidities are common in patients with cardiorenal disease; they can cause atherosclerotic cardiovascular disease (ASCVD), speed progression, and adversely affect prognosis. Common comorbidities are Type 2 diabetes mellitus (T2DM), obesity/overweight, chronic kidney disease (CKD), and chronic liver disease. The cardiovascular system, kidneys, and liver are linked to many of the same risk factors (e.g. dyslipidaemia, hypertension, tobacco use, diabetes, and central/truncal obesity), and shared metabolic and functional abnormalities lead to damage throughout these organs via overlapping pathophysiological pathways. The COVID-19 pandemic has further complicated the management of cardiometabolic diseases. Obesity, T2DM, CKD, and liver disease are associated with increased risk of poor outcomes of COVID-19 infection, and conversely, COVID-19 can lead to worsening of pre-existing ASCVD. The high rates of these comorbidities highlight the need to improve recognition and treatment of ASCVD in patients with obesity, insulin resistance or T2DM, chronic liver diseases, and CKD and equally, to improve recognition and treatment of these diseases in patients with ASCVD. Strategies to prevent and manage cardiometabolic diseases include lifestyle modification, pharmacotherapy, and surgery. There is a need for more programmes at the societal level to encourage a healthy diet and physical activity. Many pharmacotherapies offer mechanism-based approaches that can target multiple pathophysiological pathways across diseases. These include sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, selective mineralocorticoid receptor antagonists, and combined glucose-dependent insulinotropic peptide/glucagon-like peptide-1 receptor agonist. Non-surgical and surgical weight loss strategies can improve cardiometabolic disorders in individuals living with obesity. New biomarkers under investigation may help in the early identification of individuals at risk and reveal new treatment targets.
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Affiliation(s)
- Francesco Cosentino
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Solna, 171 76 Stockholm, Sweden
| | - Subodh Verma
- Division of Cardiac Surgery, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Philip Ambery
- Late-stage Development, CVRM, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | | | | | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), and German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Michele Cecchini
- Health Division, Organisation for Economic Co-operation and Development (OECD), Paris, France
| | - Paola Fioretto
- Department of Medicine, University of Padova, Padova, Italy
| | - Per-Henrik Groop
- Department of Nephrology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Institute of Genetics, Helsinki, Finland
- Department of Diabetes, Monash University, Melbourne, Australia
| | - David Hess
- Department of Physiology and Pharmacology, University of Western Ontario, Robarts Research Institute, London, ON, Canada
- Department of Pharmacology, University of Toronto, Division of Vascular Surgery, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Kamlesh Khunti
- Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Carolyn S P Lam
- National Heart Centre Singapore, Duke-National University of Singapore, Singapore
| | | | - Lars H Lund
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | | | - Philip N Newsome
- National Institute for Health Research, Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Liver & Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Scott Solomon
- Harvard Medical School, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Franz Weidinger
- 2nd Medical Department with Cardiology and Intensive Care Medicine, Klinik Landstrasse, Vienna, Austria
| | - Faiez Zannad
- Université de Lorraine, Inserm Clinical Investigation Center at Institut Lorrain du Coeur et des Vaisseaux, University Hospital of Nancy, Nancy, France
| | - Andreas Zeiher
- Cardio Pulmonary Institute, Goethe University of Frankfurt, Frankfurt, Germany
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7
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Marijon E, Narayanan K, Smith K, Barra S, Basso C, Blom MT, Crotti L, D'Avila A, Deo R, Dumas F, Dzudie A, Farrugia A, Greeley K, Hindricks G, Hua W, Ingles J, Iwami T, Junttila J, Koster RW, Le Polain De Waroux JB, Olasveengen TM, Ong MEH, Papadakis M, Sasson C, Shin SD, Tse HF, Tseng Z, Van Der Werf C, Folke F, Albert CM, Winkel BG. The Lancet Commission to reduce the global burden of sudden cardiac death: a call for multidisciplinary action. Lancet 2023; 402:883-936. [PMID: 37647926 DOI: 10.1016/s0140-6736(23)00875-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/13/2023] [Accepted: 04/25/2023] [Indexed: 09/01/2023]
Abstract
Despite major advancements in cardiovascular medicine, sudden cardiac death (SCD) continues to be an enormous medical and societal challenge, claiming millions of lives every year. Efforts to prevent SCD are hampered by imperfect risk prediction and inadequate solutions to specifically address arrhythmogenesis. Although resuscitation strategies have witnessed substantial evolution, there is a need to strengthen the organisation of community interventions and emergency medical systems across varied locations and health-care structures. With all the technological and medical advances of the 21st century, the fact that survival from sudden cardiac arrest (SCA) remains lower than 10% in most parts of the world is unacceptable. Recognising this urgent need, the Lancet Commission on SCD was constituted, bringing together 30 international experts in varied disciplines. Consistent progress in tackling SCD will require a completely revamped approach to SCD prevention, with wide-sweeping policy changes that will empower the development of both governmental and community-based programmes to maximise survival from SCA, and to comprehensively attend to survivors and decedents' families after the event. International collaborative efforts that maximally leverage and connect the expertise of various research organisations will need to be prioritised to properly address identified gaps. The Commission places substantial emphasis on the need to develop a multidisciplinary strategy that encompasses all aspects of SCD prevention and treatment. The Commission provides a critical assessment of the current scientific efforts in the field, and puts forth key recommendations to challenge, activate, and intensify efforts by both the scientific and global community with new directions, research, and innovation to reduce the burden of SCD worldwide.
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Affiliation(s)
- Eloi Marijon
- Division of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France; Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France.
| | - Kumar Narayanan
- Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France; Medicover Hospitals, Hyderabad, India
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Silverchain Group, Melbourne, VIC, Australia
| | - Sérgio Barra
- Department of Cardiology, Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal
| | - Cristina Basso
- Cardiovascular Pathology Unit-Azienda Ospedaliera and Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marieke T Blom
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Lia Crotti
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Cardiomyopathy Unit and Laboratory of Cardiovascular Genetics, Department of Cardiology, Milan, Italy
| | - Andre D'Avila
- Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Cardiology, Hospital SOS Cardio, Santa Catarina, Brazil
| | - Rajat Deo
- Department of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Florence Dumas
- Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France; Emergency Department, Cochin Hospital, Paris, France
| | - Anastase Dzudie
- Cardiology and Cardiac Arrhythmia Unit, Department of Internal Medicine, DoualaGeneral Hospital, Douala, Cameroon; Yaounde Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Audrey Farrugia
- Hôpitaux Universitaires de Strasbourg, France, Strasbourg, France
| | - Kaitlyn Greeley
- Division of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France; Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France
| | | | - Wei Hua
- Cardiac Arrhythmia Center, FuWai Hospital, Beijing, China
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research and UNSW Sydney, Sydney, NSW, Australia
| | - Taku Iwami
- Kyoto University Health Service, Kyoto, Japan
| | - Juhani Junttila
- MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Rudolph W Koster
- Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Theresa M Olasveengen
- Department of Anesthesia and Intensive Care Medicine, Oslo University Hospital and Institute of Clinical Medicine, Oslo, Norway
| | - Marcus E H Ong
- Singapore General Hospital, Duke-NUS Medical School, Singapore
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St George's University of London, London, UK
| | | | - Sang Do Shin
- Department of Emergency Medicine at the Seoul National University College of Medicine, Seoul, South Korea
| | - Hung-Fat Tse
- University of Hong Kong, School of Clinical Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region, China; Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zian Tseng
- Division of Cardiology, UCSF Health, University of California, San Francisco Medical Center, San Francisco, California
| | - Christian Van Der Werf
- University of Amsterdam, Heart Center, Amsterdam, Netherlands; Department of Clinical and Experimental Cardiology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christine M Albert
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Bo Gregers Winkel
- Department of Cardiology, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark
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Boriani G, Guerra F, De Ponti R, D'Onofrio A, Accogli M, Bertini M, Bisignani G, Forleo GB, Landolina M, Lavalle C, Notarstefano P, Ricci RP, Zanotto G, Palmisano P, De Bonis S, Pangallo A, Talarico A, Maglia G, Aspromonte V, Nigro G, Bianchi V, Rapacciuolo A, Ammendola E, Solimene F, Stabile G, Biffi M, Ziacchi M, Malpighi PSO, Saporito D, Casali E, Turco V, Malavasi VL, Vitolo M, Imberti JF, Bertini M, Anna AS, Zardini M, Placci A, Quartieri F, Bottoni N, Carinci V, Barbato G, De Maria E, Borghi A, Ramazzini OB, Bronzetti G, Tomasi C, Boggian G, Virzì S, Sassone B, Corzani A, Sabbatani P, Pastori P, Ciccaglioni A, Adamo F, Scaccia A, Spampinato A, Patruno N, Biscione F, Cinti C, Pignalberi C, Calò L, Tancredi M, Di Belardino N, Ricciardi D, Cauti F, Rossi P, Cardinale M, Ansalone G, Narducci ML, Pelargonio G, Silvetti M, Drago F, Santini L, Pentimalli F, Pepi P, Caravati F, Taravelli E, Belotti G, Rordorf R, Mazzone P, Bella PD, Rossi S, Canevese LF, Cilloni S, Doni LA, Vergara P, Baroni M, Perna E, Gardini A, Negro R, Perego GB, Curnis A, Arabia G, Russo AD, Marchese P, Dell’Era G, Occhetta E, Pizzetti F, Amellone C, Giammaria M, Devecchi C, Coppolino A, Tommasi S, Anselmino M, Coluccia G, Guido A, Rillo M, Palamà Z, Luzzi G, Pellegrino PL, Grimaldi M, Grandinetti G, Vilei E, Potenza D, Scicchitano P, Favale S, Santobuono VE, Sai R, Melissano D, Candida TR, Bonfantino VM, Di Canda D, Gianfrancesco D, Carretta D, Pisanò ECL, Medico A, Giaccari R, Aste R, Murgia C, Nissardi V, Sanna GD, Firetto G, Crea P, Ciotta E, Sgarito G, Caramanno G, Ciaramitaro G, Faraci A, Fasheri A, Di Gregorio L, Campsi G, Muscio G, Giannola G, Padeletti M, Del Rosso A, Notarstefano P, Nesti M, Miracapillo G, Giovannini T, Pieragnoli P, Rauhe W, Marini M, Guarracini F, Ridarelli M, Fedeli F, Mazza A, Zingarini G, Andreoli C, Carreras G, Zorzi A, Zanotto G, Rossillo A, Ignatuk B, Zerbo F, Molon G, Fantinel M, Zanon F, Marcantoni L, Zadro M, Bevilacqua M. 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). Intern Emerg Med 2023; 18:137-149. [PMID: 363522300 PMCID: PMC9646282 DOI: 10.1007/s11739-022-03140-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022]
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.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41121, Modena, Italy.
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo-University of Insubria, Varese, Italy
| | - Antonio D'Onofrio
- Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias, Monaldi Hospital, Naples, Italy
| | | | - Matteo Bertini
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara "Arcispedale S. Anna", Cona, Ferrara, Italy
| | - Giovanni Bisignani
- Cardiology Division, Castrovillari Hospital, ASP Cosenza, Castrovillari, Italy
| | | | | | - Carlo Lavalle
- Department of Cardiology, Policlinico Universitario Umberto I, Rome, Italy
| | | | | | - Gabriele Zanotto
- Department of Cardiology, Mater Salutis Hospital, Legnago, Verona, Italy
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Kodsi M, Bhat A. Temporal trends in cardiovascular care: Insights from the COVID-19 pandemic. Front Cardiovasc Med 2022; 9:981023. [PMID: 36426232 PMCID: PMC9680953 DOI: 10.3389/fcvm.2022.981023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/30/2022] [Indexed: 04/12/2024] Open
Abstract
In response to the ongoing COVID-19 pandemic, public health care measures have been implemented to limit spread of the contagion and ensure adequate healthcare resource allocation. Correlating with these measures are observed changes in the incidence and outcomes of cardiovascular conditions in the absence of COVID-19 infection. The pandemic has resulted in a reduction in acute coronary syndrome, heart failure and arrhythmia admissions but with worsened outcomes in those diagnosed with these conditions. This is concerning of an underdiagnosis of cardiovascular diseases during the pandemic. Furthermore, cardiovascular services and investigations have decreased to provide healthcare allocation to COVID-19 related services. This threatens an increasing future prevalence of cardiovascular morbidity in healthcare systems that are still adapting to the challenges of a continuing pandemic. Adaption of virtual training and patient care delivery platforms have been shown to be useful, but adequate resources allocation is needed to ensure effectiveness in vulnerable populations.
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Affiliation(s)
- Matthew Kodsi
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia
| | - Aditya Bhat
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
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Crea F. New tools to predict and new therapeutic targets to treat life-threatening ventricular arrhythmias. Eur Heart J 2022; 43:3983-3986. [PMID: 36265861 DOI: 10.1093/eurheartj/ehac573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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11
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Nadarajah R, Wu J, Hurdus B, Asma S, Bhatt DL, Biondi-Zoccai G, Mehta LS, Ram CVS, Ribeiro ALP, Van Spall HG, Deanfield JE, Lüscher TF, Mamas M, Gale CP. The collateral damage of COVID-19 to cardiovascular services: a meta-analysis. Eur Heart J 2022; 43:3164-3178. [PMID: 36044988 PMCID: PMC9724453 DOI: 10.1093/eurheartj/ehac227] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 04/02/2022] [Accepted: 04/20/2022] [Indexed: 07/21/2023] Open
Abstract
AIMS The effect of the COVID-19 pandemic on care and outcomes across non-COVID-19 cardiovascular (CV) diseases is unknown. A systematic review and meta-analysis was performed to quantify the effect and investigate for variation by CV disease, geographic region, country income classification and the time course of the pandemic. METHODS AND RESULTS From January 2019 to December 2021, Medline and Embase databases were searched for observational studies comparing a pandemic and pre-pandemic period with relation to CV disease hospitalisations, diagnostic and interventional procedures, outpatient consultations, and mortality. Observational data were synthesised by incidence rate ratios (IRR) and risk ratios (RR) for binary outcomes and weighted mean differences for continuous outcomes with 95% confidence intervals. The study was registered with PROSPERO (CRD42021265930). A total of 158 studies, covering 49 countries and 6 continents, were used for quantitative synthesis. Most studies (80%) reported information for high-income countries (HICs). Across all CV disease and geographies there were fewer hospitalisations, diagnostic and interventional procedures, and outpatient consultations during the pandemic. By meta-regression, in low-middle income countries (LMICs) compared to HICs the decline in ST-segment elevation myocardial infarction (STEMI) hospitalisations (RR 0.79, 95% confidence interval [CI] 0.66-0.94) and revascularisation (RR 0.73, 95% CI 0.62-0.87) was more severe. In LMICs, but not HICs, in-hospital mortality increased for STEMI (RR 1.22, 95% CI 1.10-1.37) and heart failure (RR 1.08, 95% CI 1.04-1.12). The magnitude of decline in hospitalisations for CV diseases did not differ between the first and second wave. CONCLUSIONS There was substantial global collateral CV damage during the COVID-19 pandemic with disparity in severity by country income classification.
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Affiliation(s)
- Ramesh Nadarajah
- Corresponding author. Tel: +44 113 343 3241, , Twitter @Dr_R_Nadarajah
| | - Jianhua Wu
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
- School of Dentistry, University of Leeds, Leeds, UK
| | - Ben Hurdus
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Samira Asma
- Division of Data, Analytics and Delivery for Impact, World Health Organization, Geneva, Switzerland
| | - Deepak L. Bhatt
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Laxmi S. Mehta
- Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - C. Venkata S. Ram
- Apollo Hospitals and Medical College, Hyderabad, Telangana, India
- University of Texas Southwestern Medical School, Dallas, TX, USA
- Faculty of Medical and Health Sciences, Macquarie University, Sydney, Australia
| | - Antonio Luiz P. Ribeiro
- Cardiology Service and Telehealth Center, Hospital das Clínicas, and Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Harriette G.C. Van Spall
- Department of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Population Health Research Institute, Hamilton, Canada
| | - John E. Deanfield
- National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Sciences, University College, London, UK
| | - Thomas F. Lüscher
- Imperial College, National Heart and Lung Institute, London, UK
- Royal Brompton & Harefield Hospital, Imperial College, London, UK
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Institute for Prognosis Research, University of Keele, Keele, UK
| | - Chris P. Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, 6 Clarendon Way, Leeds LS2 9DA, UK
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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12
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Huttelmaier MT, Gabel A, Seewald M, Jungbauer C, Frantz S, Störk S, Fischer TH. Impact of coronavirus disease (COVID-19) pandemic on physical activity of patients with cardiac implantable electronic devices—A remote monitoring study. PLoS One 2022; 17:e0269816. [PMID: 35960722 PMCID: PMC9374242 DOI: 10.1371/journal.pone.0269816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/30/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives The study aims to investigate the impact of COVID-19 pandemic on physical activity and frequency of implantable cardioverter-defibrillator (ICD) therapies of patients with cardiac implantable electronic devices. Methods and results Physical activity, heart rate and ICD-therapies were assessed via routine remote monitoring over two years. We focussed on a 338-day period during COVID-19 pandemic that was divided in 6 time-intervals defined by public health interventions and compared to the previous regular year. Paired nonparametric longitudinal analysis was performed to detect differences between time-intervals. To model effects of age, sex and time we applied a nonparametric ANOVA-type-statistic. 147 patients with cardiac implantable electronic devices were analysed. Longitudinal analysis of physical activity in 2019 and 2020 showed a specific weekly and seasonal pattern. Physical activity was reduced during the pandemic (mean daily physical activity 2019: 12.4% vs. 2020: 11.5%; p<0.0001) with the strongest reductions (fold changes 0.885/0.889, p<0.0001/p<0.0001) during the two lockdown-periods. In older patients (>70 years), physical activity was decreased in every time-interval of the year 2020. In time-intervals of eased restrictions, physical activity of younger patients (≤70 years) was not different compared to 2019. No variation in mean heart rate, arrhythmia-burden and count of ICD-therapies was found. Conclusion Physical activity shows fluctuations dependent on days of the week and time of the year. During the pandemic, physical activity was reduced in patients with cardiac implantable electronic devices with the strongest reductions during lockdown-periods. Younger patients resumed former levels of physical activity in times of eased restrictions while older patients remained less active. Thus, activation of the elderly population is important to prevent long-term health impairments due to the pandemic.
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Affiliation(s)
- Moritz T. Huttelmaier
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Würzburg, Würzburg, Germany
- * E-mail:
| | - Alexander Gabel
- Institut für Informatik, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Maria Seewald
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Carsten Jungbauer
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Stefan Frantz
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Stefan Störk
- Deutsches Zentrum für Herzinsuffizienz (DZHI), Universität und Universitätsklinikum Würzburg, Würzburg, Germany
| | - Thomas H. Fischer
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Würzburg, Würzburg, Germany
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Zorzi A, Mattesi G, Frigo AC, Leoni L, Bertaglia E, De Lazzari M, Cipriani A, Iliceto S, Corrado D, Migliore F. Impact of coronavirus disease 19 outbreak on arrhythmic events and mortality among implantable cardioverter defibrillator patients followed up by remote monitoring: a single center study from the Veneto region of Italy. J Cardiovasc Med (Hagerstown) 2022; 23:546-550. [PMID: 35905001 DOI: 10.2459/jcm.0000000000001348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The 2020 severe acute respiratory syndrome coronavirus 2 outbreak entailed reduced availability of traditional (in-office) cardiology consultations. Remote monitoring is an alternative way of caring that may potentially mitigate the negative effects of the epidemic to the care of cardiovascular diseases. We evaluated the outcome of implantable cardioverter defibrillator (ICD) carriers followed up remotely in 2020 (epidemic period) versus 2019 (control). METHODS We included all patients with an ICD who remained remotely monitored from the beginning to the end of each year. The combined end point included: new-onset atrial fibrillation; sustained ventricular tachycardia >170 bpm without ICD intervention; appropriate ICD intervention (either shock or antitachycardia pacing); any-cause death. Multiple events in the same patients were counted separately if occurring ≥48 h apart. RESULTS In 2020, 52 end points occurred in 37 of 366 (10%) ICD carriers [0.14/patient (95% confidence interval [CI] = 0.11-0.19)] versus 43 end points in 32 of 325 (10%) ICD carriers in 2019 [0.13/patient (95% CI = 0.10-0.18) P = 0.75]. There was no difference between the distribution of any individual end point in 2020 versus 2019 although a nonsignificant mortality increase was observed (from 2.8% to 4.6%, P = 0.19). The lowest weekly event rate occurred during the national lock down in spring 2020 but a similar trend occurred also in 2019 suggesting that the effect may not be linked to social distancing measures. CONCLUSIONS We did not observe an increase in a combined end point including arrhythmic events and mortality in ICD carriers who were remotely monitored in 2020, compared to 2019, despite the negative impact of the coronavirus disease 2019 outbreak on the healthcare system.
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Affiliation(s)
- Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova
| | | | - Anna Chiara Frigo
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova
| | - Loira Leoni
- Azienda ospedale-università di Padova, Padova, Italy
| | | | | | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova
| | - Sabino Iliceto
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova
| | - Federico Migliore
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova
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Boriani G, Burri H, Svennberg E, Imberti JF, Merino JL, Leclercq C. Current status of reimbursement practices for remote monitoring of cardiac implantable electrical devices across Europe. Europace 2022; 24:1875-1880. [PMID: 35904006 PMCID: PMC9384581 DOI: 10.1093/europace/euac118] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/09/2022] [Indexed: 12/14/2022] Open
Abstract
Remote monitoring (RM) of cardiac implantable electrical devices (CIEDs) is currently proposed as a standard of care for CIEDs follow-up, as recommended by major cardiology societies worldwide. By detecting a series of relevant device and patient-related parameters, RM is a valuable option for early detection of CIEDs' technical issues, as well as changes in parameters related to cardio-respiratory functions. Moreover, RM may allow longer spacing between in-office follow-ups and better organization of in-hospital resources. Despite these potential advantages, resulting in improved patient safety, we are still far from a widespread diffusion of RM across Europe. Reimbursement policies across Europe still show an important heterogeneity and have been considered as an important barrier to full implementation of RM as a standard for the follow-up of all the patients with pacemakers, defibrillators, devices for cardiac resynchronization, or implantable loop recorders. Indeed, in many countries, there are still inertia and unresponsiveness to the request for widespread implementation of RM for CIEDs, although an improvement was found in some countries as compared to years ago, related to the provision of some form of reimbursement. As a matter of fact, the COVID-19 pandemic has promoted an increased use of digital health for connecting physicians to patients, even if digital literacy may be a limit for the widespread implementation of telemedicine. CIEDs have the advantage of making possible RM with an already defined organization and reliable systems for data transmissions that can be easily implemented as a standard of care for present and future cardiology practice.
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Affiliation(s)
| | - Haran Burri
- Cardiac Pacing Unit, Cardiology Service, University Hospital of Geneva, 1211 Geneva, Switzerland
| | - Emma Svennberg
- Karolinska Institutet, Department of Medicine, Karolinska University Hospital Huddinge, 17177 Stockholm, Sweden
| | - Jacopo Francesco Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41124 Modena, Italy,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Josè Luis Merino
- University Hospital La Paz, Autonoma University, Arrhythmia & Robotic EP Unit, IdiPaz, 28046 Madrid, Spain
| | - Christophe Leclercq
- Department of Cardiology, University Hospital of Rennes, 35000 Rennes, France
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Vodička S, Zelko E. Differences in Treating Patients with Palpitations at the Primary Healthcare Level Using Telemedical Device Savvy before and during the COVID-19 Pandemic. MICROMACHINES 2022; 13:mi13081176. [PMID: 35893174 PMCID: PMC9330048 DOI: 10.3390/mi13081176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 12/05/2022]
Abstract
Background: Palpitations are one of most common reasons why a patient visits a general practitioner (GP) and is referred to a cardiologist. Coronavirus disease 2019 (COVID-19) has been associated with new-onset arrhythmias, which are difficult to diagnose at the primary healthcare level during pandemic-related lockdown periods. Methods: A total of 151 patients with a complaint of heart rhythm disorder were included from before and during the COVID-19 pandemic, as well as after the start of vaccination, in this cohort retrospective study. We used a telemedical device—namely, a personal electrocardiographic (ECG) sensor called Savvy—to investigate heart rhythm in patients. The primary outcome of the study was to evaluate the number of actual heart rhythm disorder patients and any differences that infection with or vaccination for COVID-19 had on patients handled in a primary healthcare setting. Results: We found a heart rhythm disorder in 8.6% of patients before the COVID-19 pandemic and in 15.2–17.9% of patients during the COVID-19 pandemic, where the difference was statistically significant (p = 0.002). During the COVID-19 pandemic, we found a heart rhythm disorder in almost 50% of patients that had tested positive for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus) more than one month ago. After the vaccinations started, we also found a heart rhythm disorder in almost 50% of non-vaccinated patients. Conclusions: Using a telemedical approach or remote consultation is a useful method, at the primary healthcare level, for diagnosing and treating patients with palpitations during times of lockdown.
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Sun C, Xie C, Bu GL, Zhong LY, Zeng MS. Molecular characteristics, immune evasion, and impact of SARS-CoV-2 variants. Signal Transduct Target Ther 2022; 7:202. [PMID: 35764603 PMCID: PMC9240077 DOI: 10.1038/s41392-022-01039-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/16/2022] [Accepted: 05/22/2022] [Indexed: 01/18/2023] Open
Abstract
The persistent COVID-19 pandemic since 2020 has brought an enormous public health burden to the global society and is accompanied by various evolution of the virus genome. The consistently emerging SARS-CoV-2 variants harboring critical mutations impact the molecular characteristics of viral proteins and display heterogeneous behaviors in immune evasion, transmissibility, and the clinical manifestation during infection, which differ each strain and endow them with distinguished features during populational spread. Several SARS-CoV-2 variants, identified as Variants of Concern (VOC) by the World Health Organization, challenged global efforts on COVID-19 control due to the rapid worldwide spread and enhanced immune evasion from current antibodies and vaccines. Moreover, the recent Omicron variant even exacerbated the global anxiety in the continuous pandemic. Its significant evasion from current medical treatment and disease control even highlights the necessity of combinatory investigation of the mutational pattern and influence of the mutations on viral dynamics against populational immunity, which would greatly facilitate drug and vaccine development and benefit the global public health policymaking. Hence in this review, we summarized the molecular characteristics, immune evasion, and impacts of the SARS-CoV-2 variants and focused on the parallel comparison of different variants in mutational profile, transmissibility and tropism alteration, treatment effectiveness, and clinical manifestations, in order to provide a comprehensive landscape for SARS-CoV-2 variant research.
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Affiliation(s)
- Cong Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Experimental Research, Sun Yat-sen University Cancer Center, Sun Yat-sen University, 510060, Guangzhou, China
| | - Chu Xie
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Experimental Research, Sun Yat-sen University Cancer Center, Sun Yat-sen University, 510060, Guangzhou, China
| | - Guo-Long Bu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Experimental Research, Sun Yat-sen University Cancer Center, Sun Yat-sen University, 510060, Guangzhou, China
| | - Lan-Yi Zhong
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Experimental Research, Sun Yat-sen University Cancer Center, Sun Yat-sen University, 510060, Guangzhou, China
| | - Mu-Sheng Zeng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Experimental Research, Sun Yat-sen University Cancer Center, Sun Yat-sen University, 510060, Guangzhou, China. .,Guangdong-Hong Kong Joint Laboratory for RNA Medicine, 510060, Guangzhou, China.
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Ducceschi V, de Divitiis M, Bianchi V, Calvanese R, Covino G, Rapacciuolo A, Russo V, Canciello M, Volpicelli M, Ammirati G, Sangiuolo R, Papaccioli G, Ciardiello C, Innocenti S, D'Onofrio A. Effects of COVID-19 lockdown on arrhythmias in patients with implantable cardioverter-defibrillators in southern Italy. J Arrhythm 2022; 38:439-445. [PMID: 35785398 PMCID: PMC9237340 DOI: 10.1002/joa3.12713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 12/23/2022] Open
Abstract
Background The effects of lockdown on non-COVID patients are varied and unexpected. The aim is to evaluate the burden of cardiac arrhythmias during a lockdown period because of COVID-19 pandemics in a population implanted with cardiac defibrillators and followed by remote monitoring. Methods In this retrospective, multicentre cohort study, we included 574 remotely monitored implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy-defibrillator (CRT-D) recipients implanted before January 1, 2019, at seven hospitals in the Campania region, comparing the burden of arrhythmias occurred during the lockdown period because of COVID-19 epidemics (from March 9 to May 1, 2020) with the arrhythmias burden of the corresponding period in 2019 (reference period). Data collection was performed through remote monitoring. Results During the lockdown period, we observed ventricular tachyarrhythmias (ventricular tachycardia or fibrillation) in 25 (4.8%) patients while in seasonal reference period we documented ventricular tachyarrhythmias in 12 (2.3%) patients; the comparison between the periods is statistically significant (P < .04). Atrial arrhythmias were detected in 38 (8.2%) subjects during the lockdown period and in 24 (5.2%) during the reference period (P < .004). Conclusion In seven hospitals in the Campania region, during the pandemic lockdown period, we observed a higher burden of arrhythmic events in ICD/CRT-D patients through device remote monitoring.
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Affiliation(s)
| | | | - Valter Bianchi
- Electrophysiology and Cardiac Pacing UnitMonaldi HospitalNaplesItaly
| | | | | | - Antonio Rapacciuolo
- Department of Advanced Biomedical SciencesFederico II University of NaplesNaplesItaly
| | - Vincenzo Russo
- Deparatment of CardiologyUniversity of Campania "Luigi Vanvitelli," Monaldi HospitalNaplesItaly
| | | | | | - Giuseppe Ammirati
- Department of Advanced Biomedical SciencesFederico II University of NaplesNaplesItaly
| | | | - Giovanni Papaccioli
- Deparatment of CardiologyUniversity of Campania "Luigi Vanvitelli," Monaldi HospitalNaplesItaly
| | | | | | - Antonio D'Onofrio
- Electrophysiology and Cardiac Pacing UnitMonaldi HospitalNaplesItaly
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18
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Sarcoplasmic Reticulum Ca2+ Dysregulation in the Pathophysiology of Inherited Arrhythmia: An Update. Biochem Pharmacol 2022; 200:115059. [DOI: 10.1016/j.bcp.2022.115059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 11/19/2022]
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19
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Abstract
Throughout 2021, the medical and scientific communities have focused on managing the acute morbidity and mortality caused by the coronavirus disease 2019 (COVID-19) pandemic. With the approval of multiple vaccines, there is a light at the end of this dark tunnel and an opportunity to focus on the future, including managing the long-term sequelae in patients who have survived acute COVID-19. In this Perspectives article, we highlight what is known about the cardiovascular sequelae in survivors of COVID-19 and discuss important questions that need to be addressed in prospective studies to understand and mitigate these lasting cardiovascular consequences, including in post-acute COVID-19 syndrome. To provide the greatest benefit to these survivors, prospective studies should begin now, with resources made available to monitor and study this population in the coming years.
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Affiliation(s)
| | - Deepak L Bhatt
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
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20
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Simovic S, Providencia R, Barra S, Kircanski B, Guerra JM, Conte G, Duncker D, Marijon E, Anic A, Boveda S. The use of remote monitoring of cardiac implantable devices during the COVID-19 pandemic: an EHRA physician survey. Europace 2022; 24:473-480. [PMID: 34410364 PMCID: PMC8499732 DOI: 10.1093/europace/euab215] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Indexed: 12/15/2022] Open
Abstract
It is unclear to what extent the COVID-19 pandemic has influenced the use of remote monitoring (RM) of cardiac implantable electronic devices (CIEDs). The present physician-based European Heart Rhythm Association (EHRA) survey aimed to assess the influence of the COVID-19 pandemic on RM of CIEDs among EHRA members and how it changed the current practice. The survey comprised 27 questions focusing on RM use before and during the pandemic. Questions focused on the impact of COVID-19 on the frequency of in-office visits, data filtering, reasons for initiating in-person visits, underutilization of RM during COVID-19, and RM reimbursement. A total of 160 participants from 28 countries completed the survey. Compared to the pre-pandemic period, there was a significant increase in the use of RM in patients with pacemakers (PMs) and implantable loop recorders (ILRs) during the COVID-19 pandemic (PM 24.2 vs. 39.9%, P = 0.002; ILRs 61.5 vs. 73.5%, P = 0.028), while there was a trend towards higher utilization of RM for cardiac resynchronization therapy-pacemaker (CRT-P) devices during the pandemic (44.5 vs. 55%, P = 0.063). The use of RM with implantable cardioverter-defibrillators (ICDs) and CRT-defibrillator (CRT-D) did not significantly change during the pandemic (ICD 65.2 vs. 69.6%, P = 0.408; CRT-D 65.2 vs. 68.8%, P = 0.513). The frequency of in-office visits was significantly lower during the pandemic (P < 0.001). Nearly two-thirds of participants (57 out of 87 respondents), established new RM connections for CIEDs implanted before the pandemic with 33.3% (n = 29) delivering RM transmitters to the patient's home address, and the remaining 32.1% (n = 28) activating RM connections during an in-office visit. The results of this survey suggest that the crisis caused by COVID-19 has led to a significant increase in the use of RM of CIEDs.
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Affiliation(s)
- Stefan Simovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34000 Kragujevac, Serbia
- Clinic for Cardiology, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Rui Providencia
- St Bartholomew’s Hospital, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Health Informatics, University College of London, London, UK
| | - Sergio Barra
- Cardiology Department, Hospital da Luz Arrabida, V. N. Gaia, Portugal
- Cardiology Department, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Bratislav Kircanski
- University Clinical Centre of Serbia, Pacemaker Centre, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Giulio Conte
- Cardiology Department, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Eloi Marijon
- University of Paris, Paris, France
- European Georges Pompidou Hospital, Cardiology Department and Cardiovascular Research Center, Paris, France
- Institut National de la Sante et de la Recherche Medicale U970, 75908 Paris Cedex 15, France
| | - Ante Anic
- Department for Cardiovascular diseases, University Hospital Center Split, Split, Croatia
| | - Serge Boveda
- Institut National de la Sante et de la Recherche Medicale U970, 75908 Paris Cedex 15, France
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France
- Universitair Ziekenhuis Brussel—VUB, Heart Rhythm Management Centre, Brussels, Belgium
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21
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Crea F. European Society of Cardiology guidance for the management of cardiovascular disease during the pandemic and a focus on long COVID. Eur Heart J 2022; 43:1017-1021. [DOI: 10.1093/eurheartj/ehac087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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22
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Abstract
HEARTLOGICTM READY FOR PRIME TIME?
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Affiliation(s)
- Ward A Heggermont
- Onze Lieve Vrouw Hospital, Hartcentrum Aalst, Moorselbaan 164, B-9300 Aalst, Belgium.,Cardiovascular Research Institute Maastricht, Maastricht University, Universiteitssingel 40, AZ-6202 Maastricht, The Netherlands
| | - Koen Van Bockstal
- Onze Lieve Vrouw Hospital, Hartcentrum Aalst, Moorselbaan 164, B-9300 Aalst, Belgium
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23
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Zhou ES, Bhatia SK. Decrease in Reported Rates of Cardiovascular Device-Related Adverse Events During the Coronavirus Disease 2019 Pandemic. Am J Cardiol 2022; 163:140-142. [PMID: 34732284 PMCID: PMC8557811 DOI: 10.1016/j.amjcard.2021.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/05/2021] [Indexed: 12/13/2022]
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24
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Ziacchi M, Calò L, D’Onofrio A, Manzo M, Dello Russo A, Santini L, Giubilato G, Carriere C, Santobuono VE, Savarese G, La Greca C, Arena G, Talarico A, Pisanò E, Giammaria M, Pangallo A, Campari M, Valsecchi S, Diemberger I. Implantable Cardioverter Defibrillator Multisensor Monitoring during Home Confinement Caused by the COVID-19 Pandemic. BIOLOGY 2022; 11:biology11010120. [PMID: 35053117 PMCID: PMC8772791 DOI: 10.3390/biology11010120] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 02/04/2023]
Abstract
Simple Summary During the COVID-19 pandemic, utilization of remote monitoring platforms was recommended. The HeartLogic algorithm identifies patients at risk of heart failure events, combining multiple sensors available on implantable cardioverter defibrillators. This analysis examined how multiple CIED sensors behave in periods of anticipated restrictions pertaining to physical activity. We demonstrated a significant drop in median activity level immediately after the implementation of stay-at-home orders, whereas there was no difference in the other contributing sensors. The weekly rate of heart failure alerts was significantly higher during the lockdown and post-lockdown than that reported in the pre-lockdown. Abstract Aims: The utilization of remote monitoring platforms was recommended amidst the COVID-19 pandemic. The HeartLogic index combines multiple implantable cardioverter defibrillator (ICD) sensors and has proved to be a predictor of impending heart failure (HF) decompensation. We examined how multiple ICD sensors behave in the periods of anticipated restrictions pertaining to physical activity. Methods: The HeartLogic feature was active in 349 ICD and cardiac resynchronization therapy ICD patients at 20 Italian centers. The period from 1 January to 19 July 2020, was divided into three phases: pre-lockdown (weeks 1–11), lockdown (weeks 12–20), post-lockdown (weeks 21–29). Results: Immediately after the implementation of stay-at-home orders (week 12), we observed a significant drop in median activity level whereas there was no difference in the other contributing parameters. The median composite HeartLogic index increased at the end of the Lockdown. The weekly rate of alerts was significantly higher during the lockdown (1.56 alerts/week/100 pts, 95%CI: 1.15–2.06; IRR = 1.71, p = 0.014) and post-lockdown (1.37 alerts/week/100 pts, 95%CI: 0.99–1.84; IRR = 1.50, p = 0.072) than that reported in pre-lockdown (0.91 alerts/week/100 pts, 95%CI: 0.64–1.27). However, the median duration of alert state and the maximum index value did not change among phases, as well as the proportion of alerts followed by clinical actions at the centers and the proportion of alerts fully managed remotely. Conclusions: During the lockdown, the system detected a significant drop in the median activity level and generated a higher rate of alerts suggestive of worsening of the HF status.
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Affiliation(s)
- Matteo Ziacchi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, 40138 Bologna, Italy;
- Correspondence: ; Tel.: +39-3476785656
| | | | - Antonio D’Onofrio
- “Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie”, Monaldi Hospital, 80131 Naples, Italy;
| | - Michele Manzo
- OO.RR. San Giovanni di Dio Ruggi d’Aragona, 84125 Salerno, Italy;
| | - Antonio Dello Russo
- Clinica di Cardiologia e Aritmologia, Università Politecnica delle Marche, “Ospedali Riuniti”, 60126 Ancona, Italy;
| | - Luca Santini
- “Giovan Battista Grassi” Hospital, 00122 Rome, Italy;
| | | | - Cosimo Carriere
- Azienda Ospedaliera Universitaria Ospedali Riuniti di Trieste—Cattinara, 34149 Trieste, Italy;
| | | | | | | | | | | | | | - Massimo Giammaria
- Division of Cardiology, Maria Vittoria Hospital, 10144 Turin, Italy;
| | - Antonio Pangallo
- Grande Ospedale Metropolitano “Bianchi-Melacrino”, 89124 Reggio Calabria, Italy;
| | - Monica Campari
- Boston Scientific Italia, 20134 Milan, Italy; (M.C.); (S.V.)
| | | | - Igor Diemberger
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, 40138 Bologna, Italy;
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25
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Crijns HJ, Sanders P, Albert CM, Lambiase PD. OUP accepted manuscript. Eur Heart J 2022; 43:1191-1197. [PMID: 35137041 PMCID: PMC9313516 DOI: 10.1093/eurheartj/ehac007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/22/2021] [Accepted: 01/06/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Prashantan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Christine M. Albert
- Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center (CMA), Los Angeles, CA, USA
| | - Pier D. Lambiase
- Department of Cardiology, University College London and Barts Heart Centre, London, UK
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26
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Diemberger I, Vicentini A, Cattafi G, Ziacchi M, Iacopino S, Morani G, Pisanò E, Molon G, Giovannini T, Russo AD, Boriani G, Bertaglia E, Biffi M, Bongiorni MG, Rordorf R, Zucchelli G. The Impact of COVID-19 Pandemic and Lockdown Restrictions on Cardiac Implantable Device Recipients with Remote Monitoring. J Clin Med 2021; 10:jcm10235626. [PMID: 34884329 PMCID: PMC8658316 DOI: 10.3390/jcm10235626] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/13/2021] [Accepted: 11/18/2021] [Indexed: 12/22/2022] Open
Abstract
From 2020, many countries have adopted several restrictions to limit the COVID-19 pandemic. The forced containment impacted on healthcare organizations and the everyday life of patients with heart disease. We prospectively analyzed data recorded from implantable defibrillators and/or cardiac resynchronization devices of Italian patients during the lockdown (LDP), post-lockdown period (PLDP) and a control period (CP) of the previous year. We analyzed device data of the period 9 March 2019–31 May 2020 of remotely monitored patients from 34 Italian centers. Patients were also categorized according to areas with high/low infection prevalence. Among 696 patients, we observed a significant drop in median activity in LDP as compared to CP that significantly increased in the PLDP, but well below CP (all p < 0.0001). The median day heart rate and heart rate variability showed a similar trend. This behavior was associated during LDP with a significant increase in the burden of atrial arrhythmias (p = 0.0150 versus CP) and of ventricular arrhythmias [6.6 vs. 1.5 per 100 patient-weeks in CP; p = 0.0026]; the latter decreased in PLDP [0.3 per 100 patient-weeks; p = 0.0035 vs. LDP]. No modifications were recorded in thoracic fluid levels. The high/low prevalence of COVID-19 infection had no significant impact. We found an increase in the arrhythmic burden in LDP coupled with a decrease in physical activity and heart rate variability, without significant modifications of transthoracic impedance, independent from COVID-19 infection prevalence. These findings suggest a negative impact of the COVID-19 pandemic, probably related to lockdown restrictions.
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Affiliation(s)
- Igor Diemberger
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum—University of Bologna, 40126 Bologna, Italy
- UOC di Cardiologia, IRCCS Policlinico S.Orsola-Malpighi, 40138 Bologna, Italy; (M.Z.); (M.B.)
- Correspondence: ; Tel.: +39-051-214-9034
| | - Alessandro Vicentini
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (A.V.); (R.R.)
| | - Giuseppe Cattafi
- Cardiologia 3, Dipartimento Cardiotoracovascolare, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy;
| | - Matteo Ziacchi
- UOC di Cardiologia, IRCCS Policlinico S.Orsola-Malpighi, 40138 Bologna, Italy; (M.Z.); (M.B.)
| | | | - Giovanni Morani
- UOC di Cardiologia, Azienda Ospedaliero Universitaria Integrata di Verona, 37126 Verona, Italy;
| | - Ennio Pisanò
- UOC di Cardiologia, Ospedale Vito Fazzi Lecce, 73100 Lecce, Italy;
| | - Giulio Molon
- UOC di Cardiologia, IRCCS Ospedale Sacro Cuore Don Calabria, 37024 Negrar, Italy;
| | | | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti”, 60126 Ancona, Italy;
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy;
| | - Emanuele Bertaglia
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, Azienda Ospedaliera Universitaria di Padova, 35128 Padova, Italy;
| | - Mauro Biffi
- UOC di Cardiologia, IRCCS Policlinico S.Orsola-Malpighi, 40138 Bologna, Italy; (M.Z.); (M.B.)
| | - Maria Grazia Bongiorni
- Second Division of Cardiology, Cardio Thoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy; (M.G.B.); (G.Z.)
| | - Roberto Rordorf
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (A.V.); (R.R.)
| | - Giulio Zucchelli
- Second Division of Cardiology, Cardio Thoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy; (M.G.B.); (G.Z.)
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27
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Wang YJ, Jin QQ, Zheng C, Lin JX, Lin YF, Xu Q, Li J, Lin JF. One-Year Recording of Cardiac Arrhythmias in a Non-Infected Population with Cardiac Implantable Devices During the COVID-19 Pandemic. Int J Gen Med 2021; 14:7337-7348. [PMID: 34737628 PMCID: PMC8560133 DOI: 10.2147/ijgm.s333093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/07/2021] [Indexed: 12/23/2022] Open
Abstract
Objective Coronavirus disease 2019 (COVID-19) was associated with a higher risk of arrhythmia in infected patients. However, there are no reports about the effect of the ongoing pandemic on arrhythmias in the non-infected population. We measured the arrhythmia burden in a non-infected population with cardiac implantable devices. Methods The arrhythmia burden during the COVID-19 pandemic was compared to a 6-month interval in the pre-COVID-19 period. The COVID-19 pandemic was divided into high-risk (17 January 2020 to 16 March 2020) and low-risk periods (17 March 2020 to 17 July 2020) according to whether there were locally infected patients. Arrhythmia burdens were compared among the pre-COVID-19, high-risk, and low-risk periods. Results A total of 219 patients with 1859 episodes were included. We observed a larger proportion of patients with atrial fibrillation (AF) during the COVID-19 pandemic (38.36% vs 26.03%, p = 0.006). There was not significantly more ventricular arrhythmia during the COVID period than the pre-COVID-19 period (p > 0.05). During the high-risk period, daily frequency of non-sustained ventricular tachycardia (NSVT) (0.0172, 0.0475 vs 0.0109, 0.0164, p < 0.05), atrial tachycardia (AT) (0.0345, 0.0518 vs 0.0164, 0.0219 p < 0.05) and AF (0.0345, 0.0432 vs 0.0164, 0.0186, p < 0.05) and daily duration of NSVT (0.1982, 0.2845 vs 0.0538, 0.1640 p < 0.05) were higher and longer than those in the pre-COVID-19 period. Regression modeling showed that the impact of COVID-19 pandemic lead to an increased onset of AF (odds ratio 2.465; p < 0.01). Patients with paroxysmal AF who had undergone a previous radiofrequency ablation had a lower burden of AF (incidence 21.43% vs 55.00%, P = 0.049, daily frequency 0.0000, 0.0027 vs 0.0000, 241.7978, P = 0.020) during the pandemic. Conclusion The COVID-19 pandemic contributed to a higher burden of arrhythmias in non-infected patients. Patients would experience a lower burden of AF following radiofrequency ablation treatment, and this effect persisted during the pandemic.
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Affiliation(s)
- Yao-Ji Wang
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Qi-Qi Jin
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Cheng Zheng
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Jia-Xuan Lin
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Yi-Fan Lin
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Que Xu
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Jin Li
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Jia-Feng Lin
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
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28
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Venturelli A, Vitolo M, Albini A, Boriani G. How did COVID-19 affect medical and cardiology journals? A pandemic in literature. J Cardiovasc Med (Hagerstown) 2021; 22:840-847. [PMID: 34482327 PMCID: PMC10100635 DOI: 10.2459/jcm.0000000000001245] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/28/2021] [Accepted: 08/03/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS The spreading speed of the COVID-19 pandemic forced the medical community to produce efforts in updating and sharing the evidence about this new disease, trying to preserve the accuracy of the data but at the same time avoiding the potentially harmful delay from discovery to implementation. The aim of our analysis was to assess the impact of the COVID-19 pandemic on medical literature in terms of proportion of COVID-19-related published papers and temporal patterns of publications within a sample of general/internal medicine and cardiology journals. METHODS We searched through PubMed scientific papers published from 1 January 2020 to 31 January 2021 about COVID-19 in ten major medical journals, of which five were in general/internal medicine and five in the cardiology field. We analyzed the proportion of COVID-19-related papers, and we examined temporal trends in the number of published papers. RESULTS Overall, the proportion of COVID-19-related papers was 18.5% (1986/10 756). This proportion was higher among the five selected general/internal medicine journals, compared with cardiology journals (23.8% vs 9.5%). The vast majority of papers were not original articles; in particular, in cardiology journals, there were 28% 'original articles', 17% 'review articles' and 55.1% 'miscellaneous', compared with 20.2%, 5.1% and 74.7% in general/internal medicine journals, respectively. CONCLUSIONS Our analysis highlights the big impact of the COVID-19 pandemic on international scientific literature. General and internal medicine journals were mainly involved, with cardiology journals only at a later time.
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Affiliation(s)
- Andrea Venturelli
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Albini
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena
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29
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Maines M, Palmisano P, Del Greco M, Melissano D, De Bonis S, Baccillieri S, Zanotto G, D’Onofrio A, Ricci RP, De Ponti R, Boriani G. Impact of COVID-19 Pandemic on Remote Monitoring of Cardiac Implantable Electronic Devices in Italy: Results of a Survey Promoted by AIAC (Italian Association of Arrhythmology and Cardiac Pacing). J Clin Med 2021; 10:jcm10184086. [PMID: 34575197 PMCID: PMC8469719 DOI: 10.3390/jcm10184086] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/18/2021] [Accepted: 09/02/2021] [Indexed: 11/21/2022] Open
Abstract
The COVID-19 pandemic has had a profound impact on the organisation of health care in Italy, with an acceleration in the development of telemedicine. To assess the impact of the COVID-19 pandemic on the spread of remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) in Italy, a survey addressed to cardiologists operating in all Italian CIED-implanting centres was launched. A total of 127 cardiologists from 116 Italian arrhythmia centres took part in the survey, 41.0% of all 283 CIED-implanting centres operating in Italy in 2019. All participating centres declared to use RM of CIEDs. COVID-19 pandemic resulted in an increase in the use of RM in 83 (71.6%) participating centres. In a temporal perspective, an increase in the median number of patients per centre followed up by RM was found from 2012 to 2017, followed by an exponential increase from 2017 to 2020. In 36 participating centres (31.0%) a telehealth visits service was activated as a replacement for in-person outpatient visits (in patients with or without CIED) during the COVID-19 pandemic. COVID-19 pandemic has caused an acceleration in the use of RM of CIEDs and in the use of telemedicine in the clinical practice of cardiology.
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Affiliation(s)
| | - Pietro Palmisano
- Cardiology Unit, “Card. G. Panico” Hospital, 73039 Tricase, Italy
- Correspondence:
| | - Maurizio Del Greco
- Santa Maria del Carmine Hospital, 38068 Rovereto, Italy; (M.M.); (M.D.G.)
| | | | - Silvana De Bonis
- Department of Cardiology, Ospedale “Ferrari”, 87012 Castrovillari, Italy;
| | | | | | - Antonio D’Onofrio
- Electrophysiology and Cardiac Pacing Unit, A.O.R.N, Ospedali dei Colli-Monaldi, 80131 Naples, Italy;
| | | | - Roberto De Ponti
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy;
| | - Giuseppe Boriani
- Department of Biomedical, Metabolic and Neural Sciences, Cardiology Division, University of Modena and Reggio Emilia, Policlinico di Modena, 41121 Modena, Italy;
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Adabag S, Madjid M, Cheng A. An attempt to reconcile the contrasting results of analyses on implantable cardioverter-defibrillator shocks during the pandemic. Eur Heart J 2021; 43:1173. [PMID: 34279030 DOI: 10.1093/eurheartj/ehab378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Selçuk Adabag
- Division of Cardiology, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417, USA.,Department of Medicine, University of Minnesota, 420 Delaware St. SE Minneapolis, MN 55455, USA
| | - Mohammad Madjid
- Department of Medicine, McGovern Medical School, UTHealth, 6431 Fannin St., MSB 1.150 Houston, Texas 77030, USA
| | - Alan Cheng
- Cardiac Rhythm Heart Failure, 710 Medtronic Parkway Minneapolis, MN 55432-5604, USA
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31
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O'Shea CJ, Middeldorp ME, Campbell K, Sanders P. Response to discussion forum letter: an attempt to reconcile the contrasting results of analyses on ICD shocks during the pandemic. Eur Heart J 2021; 43:1174-1175. [PMID: 34279020 PMCID: PMC8344693 DOI: 10.1093/eurheartj/ehab385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Catherine J O'Shea
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia.,Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | - Melissa E Middeldorp
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia.,Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia.,Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
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Covid and Cardiovascular Diseases: Direct and Indirect Damages and Future Perspective. High Blood Press Cardiovasc Prev 2021; 28:439-445. [PMID: 34173942 PMCID: PMC8233573 DOI: 10.1007/s40292-021-00464-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/27/2021] [Indexed: 02/07/2023] Open
Abstract
SARS-CoV-2 infection determines a disease that predominantly affects lungs. However the cytokines storms, determined by the huge immune response to the infection, could affect also other organs and apparatus such as heart and vessels. Beyond the acute inflammation itself also hypercoagulative status has been linked to SARSCoV-2 infection and this surely relates to the increase seen in prevalence of pulmonary embolism and myocardial infarction. A number of cardiac abnormalities and pathologies have been observed, with special attention to cardiac arrhythmias and myocardial involvement. Furthermore, indirect damages determined by the reduction in acute and chronic cardiovascular care, results in a strong mortality and morbidity outcomes in cardiological patients. In this review we will summarise current knowledge on both direct and indirect cardiovascular damages determined by the SARS-CoV-2 pandemia.
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Olszewska-Parasiewicz J, Szarpak Ł, Rogula S, Gąsecka A, Szymańska U, Kwiatkowska M, Jaguszewski MJ, Sierpiński R, Zaczyński A, Wierzba W, Kosior DA. Statins in COVID-19 Therapy. Life (Basel) 2021; 11:life11060565. [PMID: 34208435 PMCID: PMC8234902 DOI: 10.3390/life11060565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/03/2021] [Accepted: 06/11/2021] [Indexed: 01/08/2023] Open
Abstract
Inhibitors of 3-hydroxy-3methylgultaryl-coenzyme A reductase (statins) are one of the main groups of drugs used in preventing and treating cardiovascular diseases worldwide. They are widely available, cheap, and well-tolerated. Based on statins’ pleiotropic properties, including improvement of endothelial dysfunction, antioxidant properties, atherosclerotic plaque stabilization, and inhibition of inflammatory responses, it can be hypothesized that the use of statins, at least as an adjuvant in antiviral therapy, may be justified. All these effects might be especially beneficial in patients with COVID-19, suffering from endothelial dysfunction, microvascular and macrovascular thrombosis, and cytokine storm. Here, we review the recent data regarding the pathophysiology of SARS-CoV-2 activity in host cells, proposed COVID-19 therapy, the pleiotropic activity of statins, and statins in clinical trials in respiratory infections. According to the guidelines of the European and American Cardiac Societies, in patients with cardiovascular disease or high cardiovascular risk with concomitant COVID-19 it is recommended to continue statin treatment. However, the initiation of statin therapy de novo in COVID-19 treatment should only be done as part of a clinical trial.
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Affiliation(s)
- Justyna Olszewska-Parasiewicz
- Central Clinical Hospital the Ministry of the Interior and Administration, Wołoska 137, 02-507 Warsaw, Poland; (J.O.-P.); (U.S.); (M.K.); (A.Z.); (W.W.); (D.A.K.)
| | - Łukasz Szarpak
- Maria Sklodowska-Curie Białystok Oncology Centre, Ogrodowa 12, 15-027 Białystok, Poland
- Maria Sklodowska-Curie Medical Academy in Warsaw, Solidarnosci 12, 03-411 Warsaw, Poland
- Correspondence:
| | - Sylwester Rogula
- Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland; (S.R.); (A.G.)
| | - Aleksandra Gąsecka
- Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland; (S.R.); (A.G.)
| | - Urszula Szymańska
- Central Clinical Hospital the Ministry of the Interior and Administration, Wołoska 137, 02-507 Warsaw, Poland; (J.O.-P.); (U.S.); (M.K.); (A.Z.); (W.W.); (D.A.K.)
| | - Maria Kwiatkowska
- Central Clinical Hospital the Ministry of the Interior and Administration, Wołoska 137, 02-507 Warsaw, Poland; (J.O.-P.); (U.S.); (M.K.); (A.Z.); (W.W.); (D.A.K.)
| | - Milosz J. Jaguszewski
- Department of Cardiology, Medical University of Gdańsk, Dębinki 7, 80-952 Gdańsk, Poland;
| | - Radosław Sierpiński
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, 01-815 Warsaw, Poland;
| | - Artur Zaczyński
- Central Clinical Hospital the Ministry of the Interior and Administration, Wołoska 137, 02-507 Warsaw, Poland; (J.O.-P.); (U.S.); (M.K.); (A.Z.); (W.W.); (D.A.K.)
| | - Waldemar Wierzba
- Central Clinical Hospital the Ministry of the Interior and Administration, Wołoska 137, 02-507 Warsaw, Poland; (J.O.-P.); (U.S.); (M.K.); (A.Z.); (W.W.); (D.A.K.)
- UHE Satellite Campus in Warsaw, University of Humanities and Economics in Łódź, Felińskego 15, 01-513 Warsaw, Poland
| | - Dariusz A. Kosior
- Central Clinical Hospital the Ministry of the Interior and Administration, Wołoska 137, 02-507 Warsaw, Poland; (J.O.-P.); (U.S.); (M.K.); (A.Z.); (W.W.); (D.A.K.)
- Mossakowski Medical Research Institute, Polish Academy of Sciences, 02-106 Warsaw, Poland
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Eckardt L, Perings C. Vorhofflimmern im Wandel: wissen wir heute mehr als wir nicht wissen? AKTUELLE KARDIOLOGIE 2021. [DOI: 10.1055/a-1401-0863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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O'Shea CJ, Middeldorp ME, Thomas G, Harper C, Elliott AD, Ray N, Campbell K, Lau DH, Sanders P. Atrial fibrillation burden during the coronavirus disease 2019 pandemic. Europace 2021; 23:1493-1501. [PMID: 34077513 PMCID: PMC8195127 DOI: 10.1093/europace/euab099] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/30/2021] [Indexed: 01/14/2023] Open
Abstract
Aims The aim of this study is to determine the association between the coronavirus disease 2019 (COVID-19) pandemic and atrial fibrillation (AF) occurrence in individuals with cardiac implantable electronic devices (CIEDs). Method and results Multi-centre, observational, cohort study over a 100-day period during the COVID-19 pandemic (COVID-19) in the USA. Remote monitoring was used to assess AF episodes in patients with a CIED (pacemaker or defibrillator; 20 centres, 13 states). For comparison, the identical 100-day period in 2019 was used (Control). The primary outcomes were the AF burden during the COVID-19 pandemic, and the association of the pandemic with AF occurrence, as compared with 1 year prior. The secondary outcome was the association of AF occurrence with per-state COVID-19 prevalence. During COVID-19, 10 346 CIEDs with an atrial lead were monitored. There were 16 570 AF episodes of ≥6 min transmitted (16 events per 1000 patient days) with a significant increase in proportion of patients with AF episodes in high COVID-19 prevalence states compared with low prevalence states [odds ratio 1.34, 95% confidence interval (CI) 1.21–1.48, P < 0.001]. There were significantly more AF episodes during COVID-19 compared with Control [incident rate ratio (IRR) 1.33, 95% CI 1.25–1.40, P < 0.001]. This relationship persisted for AF episodes ≥1 h (IRR 1.65, 95% CI 1.53–1.79, P < 0.001) and ≥6 h (IRR 1.54, 95% CI 1.38–1.73, P < 0.001). Conclusion During the first 100 days of COVID-19, a 33% increase in AF episodes occurred with a 34% increase in the proportion of patients with AF episodes observed in states with higher COVID-19 prevalence. These findings suggest a possible association between pandemic-associated social disruptions and AF in patients with CIEDs. Clinical TRIAL registration Australian New Zealand Clinical Trial Registry: ACTRN12620000692932.
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Affiliation(s)
- Catherine J O'Shea
- Centre for Heart Rhythm Disorders, University of Adelaide, North Terrace, Adelaide, South Australia, 5000, Australia.,Department of Cardiology, Port Road, Adelaide, South Australia, 5000, Australia
| | - Melissa E Middeldorp
- Centre for Heart Rhythm Disorders, University of Adelaide, North Terrace, Adelaide, South Australia, 5000, Australia.,Department of Cardiology, Port Road, Adelaide, South Australia, 5000, Australia
| | - Gijo Thomas
- Centre for Heart Rhythm Disorders, University of Adelaide, North Terrace, Adelaide, South Australia, 5000, Australia
| | | | - Adrian D Elliott
- Centre for Heart Rhythm Disorders, University of Adelaide, North Terrace, Adelaide, South Australia, 5000, Australia
| | | | - Kevin Campbell
- Centre for Heart Rhythm Disorders, University of Adelaide, North Terrace, Adelaide, South Australia, 5000, Australia.,Pacemate, Bradenton, FL, USA
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, University of Adelaide, North Terrace, Adelaide, South Australia, 5000, Australia.,Department of Cardiology, Port Road, Adelaide, South Australia, 5000, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide, North Terrace, Adelaide, South Australia, 5000, Australia.,Department of Cardiology, Port Road, Adelaide, South Australia, 5000, Australia
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Adabag S, Zimmerman P, Black A, Madjid M, Safavi-Naeini P, Cheng A. Implantable Cardioverter-Defibrillator Shocks During COVID-19 Outbreak. J Am Heart Assoc 2021; 10:e019708. [PMID: 34044586 PMCID: PMC8483533 DOI: 10.1161/jaha.120.019708] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background COVID‐19 was temporally associated with an increase in out‐of‐hospital cardiac arrests, but the underlying mechanisms are unclear. We sought to determine if patients with implantable defibrillators residing in areas with high COVID‐19 activity experienced an increase in defibrillator shocks during the COVID‐19 outbreak. Methods and Results Using the Medtronic (Mounds View, MN) Carelink database from 2019 and 2020, we retrospectively determined the incidence of implantable defibrillator shock episodes among patients residing in New York City, New Orleans, LA, and Boston, MA. A total of 14 665 patients with a Medtronic implantable defibrillator (age, 66±13 years; and 72% men) were included in the analysis. Comparing analysis time periods coinciding with the COVID‐19 outbreak in 2020 with the same periods in 2019, we observed a larger mean rate of defibrillator shock episodes per 1000 patients in New York City (17.8 versus 11.7, respectively), New Orleans (26.4 versus 13.5, respectively), and Boston (30.9 versus 20.6, respectively) during the COVID‐19 surge. Age‐ and sex‐adjusted hurdle model showed that the Poisson distribution rate of defibrillator shocks for patients with ≥1 shock was 3.11 times larger (95% CI, 1.08–8.99; P=0.036) in New York City, 3.74 times larger (95% CI, 0.88–15.89; P=0.074) in New Orleans, and 1.97 times larger (95% CI, 0.69–5.61; P=0.202) in Boston in 2020 versus 2019. However, the binomial odds of any given patient having a shock episode was not different in 2020 versus 2019. Conclusions Defibrillator shock episodes increased during the higher COVID‐19 activity in New York City, New Orleans, and Boston. These observations may provide insights into COVID‐19–related increase in cardiac arrests.
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Affiliation(s)
- Selçuk Adabag
- Division of Cardiology Minneapolis Veterans Affairs Health Care System Minneapolis MN.,Department of Medicine University of Minnesota Minneapolis MN
| | | | - Adam Black
- Cardiac Rhythm Heart FailureMedtronic, Inc Minneapolis MN
| | - Mohammad Madjid
- Department of Medicine McGovern Medical SchoolUTHealth Houston TX
| | - Payam Safavi-Naeini
- Electrophysiology Clinical Research and Innovations Texas Heart Institute Houston TX
| | - Alan Cheng
- Cardiac Rhythm Heart FailureMedtronic, Inc Minneapolis MN
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37
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Sassone B, Virzì S, Bertini M, Pasanisi G, Manzoli L, Myers J, Grazzi G, Muser D. Impact of the COVID-19 lockdown on the arrhythmic burden of patients with implantable cardioverter-defibrillators. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1033-1038. [PMID: 34022067 PMCID: PMC8207039 DOI: 10.1111/pace.14280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/12/2021] [Accepted: 05/16/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND In Italy, a nationwide full lockdown was declared between March and May 2020 to hinder the novel coronavirus disease 2019 (COVID-19) pandemic. The potential individual health effects of long-term isolation are largely unknown. The current study investigated the arrhythmic consequences of the COVID-19 lockdown in patients with defibrillators (ICDs) living in the province of Ferrara, Italy. METHODS Both the arrhythmias and the delivered ICD therapies as notified by the devices were prospectively collected during the lockdown period (P1) and compared to those occurred during the 10 weeks before the lockdown began (P2) and during the same period in 2019 (P3). Changes in outcome over the three study periods were evaluated for significance using McNemar's test. RESULTS A total of 413 patients were included in the analysis. No differences were found concerning either arrhythmias or shocks or anti-tachycardia pacing. Only the number of patients experiencing non-sustained ventricular tachycardias (NSVTs) during P1 significantly decreased as compared to P2 (p = 0.026) and P3 (p = 0.009). The subgroup analysis showed a significant decrease in NSVTs during P1 for men (vs. P2, p = 0.014; vs. P3, p = 0.040) and younger patients (vs. P2, p = 0.002; vs. P3, p = 0.040) and for ischemic etiology (vs. P2, p = 0.003). No arrhythmic deaths occurred during P1. CONCLUSIONS The complete nationwide lockdown, as declared by the Italian government during the first COVID-19 pandemic peak, did not impact on the incidence of arrhythmias in an urban cohort of patients with ICDs.
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Affiliation(s)
- Biagio Sassone
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Department of Emergency, Division of Cardiology, SS.ma Annunziata Hospital, Ferrara, Italy.,Department of Emergency, Division of Cardiology, Delta Hospital, Ferrara, Italy
| | - Santo Virzì
- Department of Emergency, Division of Cardiology, SS.ma Annunziata Hospital, Ferrara, Italy
| | - Matteo Bertini
- Cardiological Centre, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Giovanni Pasanisi
- Department of Emergency, Division of Cardiology, Delta Hospital, Ferrara, Italy
| | - Lamberto Manzoli
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Jonathan Myers
- Division of Cardiology, VA Palo Alto, Palo Alto, California, USA.,Stanford University School of Medicine, Stanford, California, USA
| | - Giovanni Grazzi
- Centre for Exercise Science and Sport, University of Ferrara, Ferrara, Italy.,Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, Illinois, USA
| | - Daniele Muser
- Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Cardiothoracic Department, Udine Civil Hospital, Udine, Italy
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38
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Galand V, Hwang E, Gandjbakhch E, Sebag F, Marijon E, Boveda S, Leclercq C, Defaye P, Rosier A, Martins RP. Impact of COVID-19 on the incidence of cardiac arrhythmias in implantable cardioverter defibrillator recipients followed by remote monitoring. Arch Cardiovasc Dis 2021; 114:407-414. [PMID: 34088625 PMCID: PMC8141722 DOI: 10.1016/j.acvd.2021.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 12/29/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) has been a fast-growing worldwide pandemic. Aims We aimed to investigate the incidence of cardiac arrhythmias among a large French cohort of implantable cardioverter defibrillator recipients over the first 5 months of 2020. Methods Five thousand nine hundred and fifty-four implantable cardioverter defibrillator recipients were followed by remote monitoring during the COVID-19 period (from 01 January to 31 May 2020). Data were obtained from automated remote follow-up of implantable cardioverter defibrillators utilizing the Implicity® platform. For all patients, the type of arrhythmia (atrial fibrillation, ventricular tachycardia or ventricular fibrillation), the number of ventricular arrhythmia episodes and the type of implantable cardioverter defibrillator-delivered therapy were recorded. Results A total of 472 (7.9%) patients presented 4917 ventricular arrhythmia events. An increase in ventricular arrhythmia incidence was observed after the first COVID-19 case in France, and especially during weeks #10 and #11, at the time of major governmental measures, with an increase in the incidence of antitachycardia pacing delivered therapy. During the 11 weeks before the lockdown order, the curve of the percentage of live-stream television coverage of COVID-19 information matched the ventricular arrhythmia incidence. During the lockdown, the incidence of ventricular arrhythmia decreased significantly compared with baseline (0.05 ± 0.7 vs. 0.09 ± 1.2 episodes per patient per week, respectively; P < 0.001). Importantly, no correlation was observed between ventricular arrhythmia incidence and the curve of COVID-19 incidence. No changes were observed regarding atrial fibrillation/atrial tachycardia episodes over time. Conclusions An increase in ventricular arrhythmia incidence was observed in the 2 weeks before the lockdown order, at the time of major governmental measures. Ventricular arrhythmia incidence decreased dramatically during the lockdown.
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Affiliation(s)
- Vincent Galand
- Department of Cardiology and Vascular Diseases, CHU de Rennes, 35000 Rennes, France.
| | - Elliot Hwang
- Internal Medicine, St Joseph Mercy Hospital School, Ann Arbor, Michigan, United States
| | - Estelle Gandjbakhch
- Electrophysiology Unit, Cardiology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Frédéric Sebag
- Department of Medical Cardiology, Institut Mutualiste Montsouris, 75014 Paris, France
| | - Eloi Marijon
- Cardiology Department, Georges Pompidou European Hospital, 75015 Paris, France; DAI-PP Consortium, Georges Pompidou European Hospital, 75015 Paris, France
| | - Serge Boveda
- DAI-PP Consortium, Georges Pompidou European Hospital, 75015 Paris, France; Department of Cardiology, Clinique Pasteur, 31076 Toulouse, France
| | - Christophe Leclercq
- Department of Cardiology and Vascular Diseases, CHU de Rennes, 35000 Rennes, France
| | - Pascal Defaye
- Arrhythmia Department, Cardiology, University Hospital of Grenoble Alpes, 38043 Grenoble, France
| | - Arnaud Rosier
- DAI-PP Consortium, Georges Pompidou European Hospital, 75015 Paris, France; Department of Rhythmology, Hôpital Privé Jacques Cartier, Groupe GDS, 91300 Massy, France
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Bontempi L, Aboelhassan M, Cerini M, Salghetti F, Fabbricatore D, Maiolo V, Freda L, Giacopelli D, Curnis A. Could Home Monitoring parameters provide information about the impact of the pandemic period on CIED patients? A comparison between 2019 and 2020. J Cardiovasc Med (Hagerstown) 2021; 22:606-608. [PMID: 34076608 DOI: 10.2459/jcm.0000000000001193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Luca Bontempi
- Division of Cardiology, Spedali Civili Hospital, Brescia, Italy
| | | | - Manuel Cerini
- Division of Cardiology, Spedali Civili Hospital, Brescia, Italy
| | | | | | - Vincenzo Maiolo
- Division of Cardiology, Spedali Civili Hospital, Brescia, Italy
| | | | - Daniele Giacopelli
- Clinical Research, Biotronik Italia, Milano.,Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Padua, Italy
| | - Antonio Curnis
- Division of Cardiology, Spedali Civili Hospital, Brescia, Italy
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40
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Heijman J. The walk of life: Remote monitoring provides insights into physical activity during a pandemic. IJC HEART & VASCULATURE 2021; 33:100772. [PMID: 33821211 PMCID: PMC8012064 DOI: 10.1016/j.ijcha.2021.100772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Jordi Heijman
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine, and Life Sciences, Maastricht University and Maastricht UMC+, Maastricht, the Netherlands
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41
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Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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