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1.
Medicina (Kaunas) ; 58(10)2022 Oct 07.
Article in English | MEDLINE | ID: covidwho-2066254

ABSTRACT

Irreversible electroporation (IRE) ablation is a novel treatment option for localized prostate cancer. Here, we present a case of an abrupt and fatal arrhythmia during the IRE procedure in a prostate cancer patient with an implanted permanent pacemaker. A 78-year-old male patient with a pacemaker due to sick sinus syndrome and syncope was scheduled for IRE prostate ablation surgery under general anesthesia. He had a history of recovering from coronavirus disease 2019 (COVID-19) after having been vaccinated against it and recovered without sequalae. Pacemaker interrogation and reprogramming to asynchronous AOO mode was carried out before surgery, however, sinus pause occurred repeatedly during ablation pulse delivery. After the first sinus pause of 2.25 s there was a decrease in continuous arterial blood pressure (ABP). During the delivery of the second and third pulses, identical sinus pauses were observed due to failure to capture. However, the atrial-paced rhythm recovered instantly, and vital signs became acceptable. Although sinus pause recovered gradually, the duration thereof was increased by the delivery of more IRE pulses, with a subsequent abrupt decrease seen in blood pressure. The pacemaker was urgently reprogrammed to DOO mode, after which there were no further pacing failures and no hemodynamic adverse events. For patients with pacemakers, close cardiac monitoring in addition to the interrogation of the pacemaker during the electromagnetic interference (EMI) procedure is recommended, especially in the case of having a disease that may aggravate cardiac vulnerability, such as COVID-19.


Subject(s)
COVID-19 , Pacemaker, Artificial , Prostatic Neoplasms , Male , Humans , Aged , Prostatic Neoplasms/surgery , Prostate , Pacemaker, Artificial/adverse effects , Postoperative Complications , Electroporation/methods
2.
Am J Cardiol ; 176: 105-111, 2022 08 01.
Article in English | MEDLINE | ID: covidwho-1866798

ABSTRACT

New-onset left bundle branch block (NLBBB) is the most common complication after transcatheter aortic valve implantation (TAVI). Expert consensus recommends temporary transvenous pacemaker (TTVP) support for 24 hours in these patients. To date, no study has examined TTVP use during the index hospitalization in detail. Therefore, we aimed to assess TTVP use in patients with TAVI who developed NLBBB. In this prospective observational study, we performed a detailed analysis of 24-hour telemetry in patients who developed NLBBB during TAVI. Baseline characteristics and procedural and postprocedural data were recorded. The primary outcome was pacing by the TTVP. We evaluated inappropriate TTVP use, electrophysiology study findings, permanent pacemaker (PPM) implantation, and NLBBB resolution. A total of 83 patients (74.4 ± 8.7 years, 41% female) developed NLBBB during TAVI. During index hospitalization, 1 patient (1%) required TTVP because of complete heart block and received a PPM. Five of the 83 (6%) patients were inappropriately paced, and 1 patient (1%) had ventricular fibrillation, likely secondary to TTVP. A total of 34 patients (41%) underwent electrophysiology study during hospitalization, with 4 of 83 (5%) subsequently receiving a PPM. One (1%) patient died during hospitalization, and 9 patients were lost to follow-up because of the COVID-19 pandemic. Of the remaining 73 patients with a 30-day follow-up, NLBBB had resolved in 36 (49%) at 30 days, and 2 (3%) were readmitted with complete heart block and received PPM. In conclusion, in patients with TAVI who develop NLBBB, temporary pacing is rarely necessary, may carry additional risks to the patient, and prolong hospitalization time.


Subject(s)
Aortic Valve Stenosis , Atrioventricular Block , COVID-19 , Pacemaker, Artificial , Transcatheter Aortic Valve Replacement , Aortic Valve/surgery , Aortic Valve Stenosis/complications , Arrhythmias, Cardiac/therapy , Atrioventricular Block/etiology , Bundle-Branch Block/epidemiology , Bundle-Branch Block/etiology , Bundle-Branch Block/therapy , COVID-19/epidemiology , Cardiac Pacing, Artificial/adverse effects , Female , Humans , Male , Pacemaker, Artificial/adverse effects , Pandemics , Postoperative Complications/epidemiology , Transcatheter Aortic Valve Replacement/adverse effects , Treatment Outcome
3.
Minerva Cardiol Angiol ; 70(3): 298-302, 2022 06.
Article in English | MEDLINE | ID: covidwho-1841791

ABSTRACT

BACKGROUND: Permanent cardiac pacing is the therapy of choice for treating severe and/or symptomatic bradyarrhythmia. During the COVID-19 outbreak, it has been reported a decrease in the incidence of acute coronary syndrome, but few data are available about pacemaker implantation rates. This study aimed to analyze patients referred to our center with permanent cardiac pacing indication during the COVID-19 outbreak. METHODS: We compared the number, the characteristics and the outcomes of patients who underwent urgent pacemaker implantation between March and April 2019 (Group I) with those performed in the corresponding 2020 period (Group II). RESULTS: A total of 27 patients (Group I) were implanted in March-April 2019 and 34 patients (Group II) in the corresponding 2020 period. In both groups, about half of the patients received a dual-chamber pacemaker. No significant differences in baseline patients' characteristics were observed. The most frequent indication was advanced atrio-ventricular block with a prevalence of 78% and 62% in Group I and II, respectively. The rate of procedural complications, the in-hospital and 1-month mortality were also similar between the two groups. CONCLUSIONS: In our regional referral center, we observed a routine activity in terms of urgent pacemaker implantations for the treatment of symptomatic bradyarrhythmia during the COVID-19 outbreak.


Subject(s)
COVID-19 , Pacemaker, Artificial , Aged , Bradycardia/epidemiology , Bradycardia/etiology , Bradycardia/therapy , COVID-19/epidemiology , COVID-19/therapy , Cardiac Pacing, Artificial/adverse effects , Humans , Pacemaker, Artificial/adverse effects , Pandemics
4.
Pacing Clin Electrophysiol ; 45(4): 574-577, 2022 04.
Article in English | MEDLINE | ID: covidwho-1794593

ABSTRACT

A middle-aged woman presented with symptomatic complete heart block and underwent an uneventful dual chamber pacemaker implantation. Three weeks post procedure, she developed left arm pain and weakness, with neurological localization to the lower trunk of left brachial plexus. Possibilities of traumatic compression by the device/leads or postoperative idiopathic brachial plexopathy were considered. After ruling out traumatic causes, she was started on oral steroids, to which she responded remarkably. This case highlights the importance of recognizing this rare cause of brachial plexopathy following pacemaker implantation, because not only does an expedited diagnosis and medical treatment lead to prompt recovery with minimal neurological deficits, but it also circumvents an unnecessary surgical re-exploration.


Subject(s)
Brachial Plexus Neuropathies , Brachial Plexus , Pacemaker, Artificial , Brachial Plexus Neuropathies/diagnosis , Brachial Plexus Neuropathies/etiology , Female , Humans , Middle Aged , Pacemaker, Artificial/adverse effects
5.
Cardiovasc J Afr ; 33(1): 36-40, 2022.
Article in English | MEDLINE | ID: covidwho-1771671

ABSTRACT

Pacemaker endocarditis is rare and symptoms may be misleading. If missed, it carries significant morbidity and mortality, particularly in the elderly. Advances in multi-modality imaging in recent years have emphasised its role in clinical decision making. This case highlights the ability of multi-modality imaging techniques to individualise diagnosis, management and prognosis in patients with suspected cardiovascular implantable electronic device (CIED) endocarditis.


Subject(s)
Defibrillators, Implantable , Echocardiography, Three-Dimensional , Endocarditis , Pacemaker, Artificial , Prosthesis-Related Infections , Aged , Defibrillators, Implantable/adverse effects , Endocarditis/diagnostic imaging , Endocarditis/etiology , Endocarditis/therapy , Humans , Pacemaker, Artificial/adverse effects , Prosthesis-Related Infections/diagnostic imaging , Prosthesis-Related Infections/etiology , Prosthesis-Related Infections/therapy , Tomography
6.
G Ital Cardiol (Rome) ; 23(1): 4-9, 2022 01.
Article in Italian | MEDLINE | ID: covidwho-1714846

ABSTRACT

BACKGROUND: The COVID-19 pandemic caused by SARS-CoV-2 has greatly modified outpatient follow-ups. The aim of this retrospective study was to evaluate the organizational modalities and clinical effects of rearrangements of pacemaker (PM) and implantable cardioverter-defibrillator (ICD) outpatient visits performed in our centers at Ravenna and Lugo Hospitals, Italy, during the pandemic outbreak in 2020. METHODS: All scheduled in-person device follow-up visits in March-December 2020 have been considered. On the basis of documented past functioning of each device and of remote monitoring (RM) capabilities, in-person visits were either performed or postponed at variable times. The characteristics of the follow-ups and the device-related clinically relevant events were analyzed, the latter being further divided into serious malfunction and problems to be corrected by device reprogramming. RESULTS: Overall, 27% of in-person visits were postponed (n = 576) (36% of ICDs and 25% of PMs), peaking 62% in March-May 2020. RM compensated nearly all hold-ups in ICDs and just 63% of postponements in PMs. The postponement-caused delay between in-person visits was 5.6 ± 1.1 months for ICDs and 4.7 ± 1.2 months for PMs; in 24% of ICDs the time interval between in-person visits was ≥18 months. Clinically relevant events were 56 (18 [4.4%] in ICDs, 38 [2.1%] in PMs), with no deaths and 21 serious malfunctions (4 [1%] in ICDs, 15 [0.8%] in PMs). RM identified all ICD malfunctions, while it was not available in the affected PMs. In comparison with the year 2019, serious malfunctions increased, though the difference was not significant. Monthly RM transmissions increased by 2.3 fold. CONCLUSIONS: In our single-center experience during the COVID-19 pandemic, numerous in-person PM/ICD follow-up visits were postponed, and delays were well beyond the previously recommended time limits. However, device-related malfunctions did not increase, notably, when RM capabilities were used.


Subject(s)
COVID-19 , Defibrillators, Implantable , Pacemaker, Artificial , Electronics , Follow-Up Studies , Humans , Pandemics , Retrospective Studies , SARS-CoV-2
7.
Cardiol Young ; 32(6): 1001-1003, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1683888

ABSTRACT

A young child presented with hepatomegaly, ascites and bradycardia in the setting of COVID-19. Permanent complete atrioventricular block and severe right heart failure were diagnosed. He was treated with surgical epicardial pacemaker implantation. This report is the first description of COVID-19-induced permanent complete atrioventricular block in a child.


Subject(s)
Atrioventricular Block , COVID-19 , Pacemaker, Artificial , Ventricular Dysfunction, Right , Atrioventricular Block/diagnosis , Atrioventricular Block/etiology , Atrioventricular Block/therapy , Bradycardia/diagnosis , Bradycardia/etiology , COVID-19/complications , Child , Humans , Male , Ventricular Dysfunction, Right/etiology
8.
Pacing Clin Electrophysiol ; 45(6): 815-817, 2022 06.
Article in English | MEDLINE | ID: covidwho-1673251

ABSTRACT

We report a case in which real-time remote interrogation and reprogramming of the parameters of a dual-chamber pacemaker was performed during the COVID-19 pandemic. The described case demonstrated the safety and effectiveness of CIED remote programming based on the 5G cloud technology support platform (5G-CTP), and showed that the application of real-time remote programming would help in reducing the risk of cross-infection between doctors and patients.


Subject(s)
COVID-19 , Pacemaker, Artificial , Humans , Pandemics
9.
Pediatr Cardiol ; 43(4): 784-789, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1544414

ABSTRACT

Decreased physical activity is associated with cardiovascular, metabolic and mental health disease. While decreases in physical activity during the COVID-19 pandemic have been described in the general population, there is a paucity of data regarding children with underlying cardiovascular disease. We hypothesized there would be a decrease in physical activity at the onset of the COVID-19 pandemic. Performed a single-center, retrospective cohort study of children aged < 19 years with cardiac rhythm management devices. Patients were included if they had device-measured physical activity data from > 80% of dates from February 3, 2020 through June 30, 2020. Patients with significant neurologic/neuromuscular disease were excluded. We identified 144 patients with a median age of 15.4 years. 47% were female. 34% had congenital heart disease, 20% had cardiomyopathy, 19% had an inherited arrhythmia syndrome and 5% had atrioventricular block without congenital heart disease. 47% of patients had an implantable loop recorder, 29% had a permanent pacemaker and 24% had an implantable cardioverter-defibrillator. We observed a significant decrease in device-measured physical activity from baseline (February 3-March 9), with up to a 21% decrease in physical activity during mid-March through early May. Activity levels returned to pre-pandemic levels in June. Physical activity sharply declined in children with cardiac rhythm management devices at the onset of the COVID-19 pandemic. These data highlight the importance of finding strategies to maintain physical activity during the current pandemic and future public health crises.


Subject(s)
COVID-19 , Defibrillators, Implantable , Pacemaker, Artificial , Adolescent , COVID-19/epidemiology , Child , Female , Humans , Pandemics , Retrospective Studies
10.
Int J Environ Res Public Health ; 18(22)2021 11 18.
Article in English | MEDLINE | ID: covidwho-1523990

ABSTRACT

(1) Introduction: In the last two decades, telemedicine has been increasingly applied to telemonitoring (TM) of patients with pacemakers; however, presently, its growth has significantly accelerated because of the COVID-19 pandemic, which has pushed patients and healthcare workers alike to seek new ways to stay healthy with minimal physical contact. Therefore, the main objective of this study was to update the current knowledge on the differences in the medium-and long-term effectiveness of TM and conventional monitoring (CM) in relation to costs and health outcomes. (2) Methods: Three databases and one scientific registry were searched (PubMed, EMBASE, Scopus, and Google Scholar), with no restrictions on language or year of publication. Studies published until July 2021 were included. The inclusion criteria were: (a) experimental or observational design, (b) complete economic evaluation, (c) patients with implanted pacemakers, and (d) comparison of TM with CM. Measurements of study characteristics (author, study duration, sample size, age, sex, major indication for implantation, and pacemaker used), analysis, significant results of the variables (analysis performed, primary endpoints, secondary endpoints, health outcomes, and cost outcomes), and further miscellaneous measurements (methodological quality, variables coded, instrument development, coder training, and intercoder reliability, etc.) were included. (3) Results: 11 studies met the inclusion criteria, consisting of 3372 enrolled patients; 1773 (52.58%) of them were part of randomized clinical trials. The mean age was 72 years, and the atrioventricular block was established as the main indication for device implantation. TM was significantly effective in detecting the presence or absence of pacemaker problems, leading to a reduction in the number of unscheduled hospital visits (8.34-55.55%). The cost of TM was up to 87% lower than that of CM. There were no significant differences in health-related quality of life (HRQoL) and the number of cardiovascular events. (4) Conclusions: Most of the studies included in this systematic review confirm that in the TM group of patients with pacemakers, cardiovascular events are detected and treated earlier, and the number of unscheduled visits to the hospital is significantly reduced, without affecting the HRQoL of patients. In addition, with TM modality, both formal and informal costs are significantly reduced in the medium and long term.


Subject(s)
COVID-19 , Pacemaker, Artificial , Aged , Cost-Benefit Analysis , Humans , Pandemics , Quality of Life , Reproducibility of Results , SARS-CoV-2
11.
Heart Rhythm ; 19(2): 217-218, 2022 02.
Article in English | MEDLINE | ID: covidwho-1507870
13.
Rev Esp Cardiol (Engl Ed) ; 74(12): 1084-1094, 2021 Dec.
Article in English, Spanish | MEDLINE | ID: covidwho-1487943

ABSTRACT

INTRODUCTION AND OBJECTIVES: This report describes the cardiac pacing activity performed in Spain in 2020, including the number and type of implanted devices, demographic and clinical factors, and data on remote monitoring. METHODS: Information consisted of the European Pacemaker Patient Card, data submitted to the cardiodispositivos.es online platform, the databases of participating centers, and supplier-reported data. RESULTS: A total of 14 662 procedures were registered from 102 hospitals, representing 39.2% of the estimated activity. The implantation rates of conventional and low-energy resynchronization pacemakers were 759 and 31 units per million population, respectively. In all, 520 leadless pacemakers were implanted, 70 with atrioventricular synchrony. The mean age at implantation was high (78.8 years), and the most frequent electrocardiographic change was atrioventricular block. There was a predominance of dual-chamber pacing mode but VVI/R single-chamber pacing was used in 19% of patients in sinus rhythm, depending on age and sex. Remote monitoring capability was present in 18.5% of implanted conventional pacemakers and 45.6% of low-energy resynchronization pacemakers, although registration in this system increased by 53% in 2020. CONCLUSIONS: In 2020, in the context of the SARS-CoV-2 pandemic, the number of implanted conventional pacemakers decreased by 8% and cardiac resynchronization therapy by 4.6%. The number of leadless pacemakers increased by 16.5%. Sequential pacing was predominant, influenced by age and sex. Home monitoring played a fundamental role as a mode of follow-up in this SARS-CoV-2 pandemic year.


Subject(s)
COVID-19 , Cardiac Resynchronization Therapy , Cardiology , Pacemaker, Artificial , Cardiac Pacing, Artificial , Humans , Registries , SARS-CoV-2 , Societies, Medical
14.
Card Electrophysiol Clin ; 14(1): 125-131, 2022 03.
Article in English | MEDLINE | ID: covidwho-1487632

ABSTRACT

During the coronavirus disease 2019 (COVID-19) worldwide pandemic, patients with cardiac implantable electronic device (CIED) refused scheduled follow-up visits because of the risk of infection. In this scenario, different telemedicine strategies have been implemented to ensure continuity of care to CIED patients. Patients can be monitored through dedicated applications, telephone calls, or virtual visits providing easy access to valuable information, such as arrhythmic events, acute decompensation manifestations, and device-related issues, without the need for in-person visits. This review provides a comprehensive description of the many possible applications of telemedicine for CIED patients during the COVID-19 period.


Subject(s)
COVID-19 , Defibrillators, Implantable , Pacemaker, Artificial , Telemedicine , Electronics , Humans , Pandemics , SARS-CoV-2
15.
Heart Rhythm ; 19(2): 206-216, 2022 02.
Article in English | MEDLINE | ID: covidwho-1482622

ABSTRACT

BACKGROUND: Cardiac implantable electronic device (CIED) implantation rates as well as the clinical and procedural characteristics and outcomes in patients with known active coronavirus disease 2019 (COVID-19) are unknown. OBJECTIVE: The purpose of this study was to gather information regarding CIED procedures during active COVID-19, performed with personal protective equipment, based on an international survey. METHODS: Fifty-three centers from 13 countries across 4 continents provided information on 166 patients with known active COVID-19 who underwent a CIED procedure. RESULTS: The CIED procedure rate in 133,655 hospitalized COVID-19 patients ranged from 0 to 16.2 per 1000 patients (P <.001). Most devices were implanted due to high-degree/complete atrioventricular block (112 [67.5%]) or sick sinus syndrome (31 [18.7%]). Of the 166 patients in the study survey, the 30-day complication rate was 13.9% and the 180-day mortality rate was 9.6%. One patient had a fatal outcome as a direct result of the procedure. Differences in patient and procedural characteristics and outcomes were found between Europe and North America. An older population (76.6 vs 66 years; P <.001) with a nonsignificant higher complication rate (16.5% vs 7.7%; P = .2) was observed in Europe vs North America, whereas higher rates of critically ill patients (33.3% vs 3.3%; P <.001) and mortality (26.9% vs 5%; P = .002) were observed in North America vs Europe. CONCLUSION: CIED procedure rates during known active COVID-19 disease varied greatly, from 0 to 16.2 per 1000 hospitalized COVID-19 patients worldwide. Patients with active COVID-19 infection who underwent CIED implantation had high complication and mortality rates. Operators should take these risks into consideration before proceeding with CIED implantation in active COVID-19 patients.


Subject(s)
Atrioventricular Block , COVID-19 , Infection Control , Postoperative Complications , Prosthesis Implantation , SARS-CoV-2/isolation & purification , Sick Sinus Syndrome , Aged , Atrioventricular Block/epidemiology , Atrioventricular Block/therapy , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/therapy , Comorbidity , Defibrillators, Implantable/statistics & numerical data , Female , Global Health/statistics & numerical data , Humans , Infection Control/instrumentation , Infection Control/methods , Infection Control/organization & administration , Male , Middle Aged , Mortality , Outcome Assessment, Health Care , Pacemaker, Artificial/statistics & numerical data , Postoperative Complications/diagnosis , Postoperative Complications/mortality , Prosthesis Implantation/adverse effects , Prosthesis Implantation/instrumentation , Prosthesis Implantation/mortality , Risk Factors , Sick Sinus Syndrome/epidemiology , Sick Sinus Syndrome/therapy , Surveys and Questionnaires
16.
J Infect Dev Ctries ; 15(9): 1277-1280, 2021 09 30.
Article in English | MEDLINE | ID: covidwho-1478148

ABSTRACT

INTRODUCTION: The estimated infection rate after permanent endocardial lead implantation is between 1% and 2%. Pacemaker lead endocarditis is treated with total removal of the infected device and proper antibiotics. In this case report, we present a patient with delayed diagnosis and treatment due to the COVID-19 outbreak. CASE REPORT: An 88-year-old, pacemaker dependent woman with diagnosed pacemaker pocket infection was admitted to the University Cardiovascular institute. The patient had a prolonged follow-up time due to the COVID-19 outbreak. She missed her routine checkup and came to her local hospital when the generator had already protruded completely, to the point where she held it in her own hand. Transthoracic echocardiogram showed possible vegetations on the lead. Transesophageal echocardiography was not performed due to the COVID-19 pandemic. On the day after the admission the patient underwent transvenous removal of the pacemaker lead using a 9 French gauge rotational extraction sheathe (Cook Medical). The extracted lead was covered in a thin layer of vegetations. Further follow-ups showed good recovery with no complications. CONCLUSIONS: A case showing delayed treatment of pacemaker pocket infection, due to delayed follow-up time during the COVID-19 pandemic. This patient underwent successful transvenous removal of the infected pacemaker lead, along with adequate antibiotic therapy, which has proven to be the most effective method of treating cardiac device-related endocarditis.


Subject(s)
Device Removal , Pacemaker, Artificial/adverse effects , Prosthesis-Related Infections/diagnosis , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , COVID-19 , Female , Humans , Prosthesis-Related Infections/therapy , Time-to-Treatment
17.
Arch Osteoporos ; 16(1): 129, 2021 09 09.
Article in English | MEDLINE | ID: covidwho-1471836

ABSTRACT

PURPOSE: In patients with a cardiac pacemaker, pocket-related complications such as nerve impairment or bone fractures are infrequent. We present a man with a fracture of the 4th rib several months after pacemaker implantation. CASE PRESENTATION: A 74-year-old man, with a left prepectoral pacemaker implanted 13 months ago, presented complaining of chest pain. The pain started after a sudden trunk rotation and right arm flexion movement with a crack. There was tenderness to palpation and crepitation over the left upper ribs. Computed tomography identified a non-displaced fracture line in the anterior aspect of the left 4th rib. After kinesiotaping and activity restriction, pain alleviated. CONCLUSION: Pacemaker implantation might have caused shoulder dysfunction and pectoral tightness resulting in reduced flexibility of the trunk. Consequently, a reaching motion of the arm with a trunk rotation might have directed rotational force vectors towards the osteopenic left 4th rib causing a fragility fracture. In elderly with a pacemaker, osteopenia and concomitant sarcopenia may create a predisposition to this atypical complication.


Subject(s)
Pacemaker, Artificial , Rib Fractures , Aged , Humans , Male , Movement , Pacemaker, Artificial/adverse effects , Rib Fractures/diagnostic imaging , Rib Fractures/etiology , Ribs/diagnostic imaging , Tomography, X-Ray Computed
20.
J Cardiovasc Med (Hagerstown) ; 23(1): 22-27, 2022 01 01.
Article in English | MEDLINE | ID: covidwho-1430637

ABSTRACT

AIMS: The coronavirus disease-19 (COVID-19) outbreak has been recently associated with lower hospitalization rates for acute coronary syndromes. Aim of the study was to investigate whether a similar behaviour is observed in admissions for urgent pacemaker implant. METHODS: This retrospective study included 1315 patients from 18 hospitals in Northern Italy with a high number of COVID-19 cases. Hospitalization rates for urgent pacemaker implant were compared between the following periods: 20 February to 20 April 2020 (case period); from 1 January to 19 February 2020 (intra-year control period); from 20 February to 20 April 2019 (inter-year control period). RESULTS: The incidence rate of urgent implants was 5.0/day in the case period, 6.0/day in the intra-year control period and 5.8/day in the inter-year control period. Incidence rate in the case period was significantly lower than both the intra-year [incidence rate ratio (IRR): 0.81, 95% CI 0.67-0.99, P = 0.040] and inter-year control periods (IRR: 0.79, 95% CI 0.66-0.95, P = 0.012); this reduction was highest after the national lockdown (IRR 0.68, 95% CI 0.52-0.91, P = 0.009). The prevalence of residents in rural areas undergoing urgent pacemaker implant was lower in the case period (36%) than in both the intra-year (47%, P = 0.03) and inter-year control periods (51%, P = 0.002). Elective pacemaker implants also decreased in the case period, with the incidence rate here being 3.5/day vs. 6.4/day in the intra-year (-45%) and 6.9/day in the inter-year period (-49%). CONCLUSION: Despite severe clinical patterns, the COVID-19 outbreak has negatively affected the population presentation to Emergency Departments for bradyarrhythmias requiring urgent pacemaker implant in Northern Italy. This mainly occurred after the national lockdown and concerned patients living in rural areas.


Subject(s)
Bradycardia/epidemiology , Bradycardia/therapy , COVID-19/epidemiology , Disease Outbreaks/statistics & numerical data , Elective Surgical Procedures/statistics & numerical data , Emergencies/epidemiology , Pacemaker, Artificial/statistics & numerical data , Aged , Aged, 80 and over , Female , Hospitalization/statistics & numerical data , Humans , Incidence , Italy/epidemiology , Male , Retrospective Studies
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