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1.
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
2.
Europace ; 23(3): 456-463, 2021 03 08.
Article in English | MEDLINE | ID: covidwho-1087744

ABSTRACT

AIMS: During the COVID-19 pandemic, concern regarding its effect on the management of non-communicable diseases has been raised. However, there are no data on the impact on cardiac implantable electronic devices (CIED) implantation rates. We aimed to determine the impact of SARS-CoV2 on the monthly incidence rates and type of pacemaker (PM) and implantable cardiac defibrillator (ICD) implantations in Catalonia before and after the declaration of the state of alarm in Spain on 14 March 2020. METHODS AND RESULTS: Data on new CIED implantations for 2017-20 were prospectively collected by nine hospitals in Catalonia. A mixed model with random intercepts corrected for time was used to estimate the change in monthly CIED implantations. Compared to the pre-COVID-19 period, an absolute decrease of 56.5% was observed (54.7% in PM and 63.7% in ICD) in CIED implantation rates. Total CIED implantations for 2017-19 and January and February 2020 was 250/month (>195 PM and >55 ICD), decreasing to 207 (161 PM and 46 ICD) in March and 131 (108 PM and 23 ICD) in April 2020. In April 2020, there was a significant fall of 185.25 CIED implantations compared to 2018 [95% confidence interval (CI) 129.6-240.9; P < 0.001] and of 188 CIED compared to 2019 (95% CI 132.3-243.7; P < 0.001). No significant differences in the type of PM or ICD were observed, nor in the indication for primary or secondary prevention. CONCLUSIONS: During the first wave of the COVID-19 pandemic, a substantial decrease in CIED implantations was observed in Catalonia. Our findings call for measures to avoid long-term social impact.


Subject(s)
COVID-19 , Defibrillators, Implantable/trends , Pacemaker, Artificial/trends , Practice Patterns, Physicians'/trends , Prosthesis Implantation/trends , Humans , Patient Safety , Prospective Studies , Prosthesis Implantation/instrumentation , Spain , Time Factors
3.
J Vasc Surg Venous Lymphat Disord ; 9(5): 1093-1098, 2021 09.
Article in English | MEDLINE | ID: covidwho-1039471

ABSTRACT

In response to the pandemic, an abrupt pivot of Vascular Quality Initiative physician members away from standard clinical practice to a restrictive phase of emergent and urgent vascular procedures occurred. The Society for Vascular Surgery Patient Safety Organization queried both data managers and physicians in May 2020. Approximately three-fourths (74%) of physicians adopted restrictive operating policies for urgent and emergent cases only, whereas one-half proceeded with "time sensitive" elective cases as urgent. Data manager case entry was negatively affected by both low case volumes and staffing due to reassignment or furlough. Venous registry volumes were reduced fivefold in the first quarter of 2020 compared with a similar period in 2019. The consequences of delaying vascular procedures for ambulatory venous practice remain unknown with increased morbidity likely. Challenges to determine venous thromboembolism mortality impact exist given difficulty in verifying "in home and extended care facility" deaths. Further ramifications of a pandemic shutdown will likely be amplified if postponement of elective vascular care extends beyond a short window of time. It will be important to monitor disease progression and case severity as a result of policy shifts adopted locally in response to pandemic surges.


Subject(s)
COVID-19 , Practice Patterns, Physicians'/trends , Prosthesis Implantation/trends , Surgeons/trends , Varicose Veins/therapy , Vascular Surgical Procedures/trends , Vena Cava Filters/trends , Venous Thromboembolism/therapy , Elective Surgical Procedures/trends , Health Care Surveys , Humans , Prosthesis Implantation/adverse effects , Prosthesis Implantation/instrumentation , Registries , Time Factors , Treatment Outcome , Varicose Veins/diagnostic imaging , Vascular Surgical Procedures/adverse effects , Venous Thromboembolism/diagnostic imaging , Workload
4.
Multimed Man Cardiothorac Surg ; 20202020 Dec 23.
Article in English | MEDLINE | ID: covidwho-1007098

ABSTRACT

We describe the insertion of the Impella 5.0, a peripherally placed mechanical cardiovascular microaxial pump, in a patient with ischemic left ventricular dysfunction. The Impella is a 7 Fr device capable of achieving a flow of 4.0-5.0 L/min; its use necessitates an open arterial cut-down. A subclavicular incision is used to access the right or left axillary artery. A 10-mm tube graft is anastomosed to the artery through which the Impella 5.0 is inserted. The device traverses the tube graft and is advanced via the aorta, across the aortic valve, to its final position (inflow toward the ventricular apex and outflow above the aorta). The device may remain in situ for 10 days until recovery or until further supports are instituted. Our goal is to demonstrate the insertion of the Impella 5.0 device in a patient with cardiogenic shock whose situation was further complicated by coronavirus disease 2019.


Subject(s)
Assisted Circulation , COVID-19 , Heart-Assist Devices , Prosthesis Implantation , ST Elevation Myocardial Infarction , Shock, Cardiogenic , Adult , Assisted Circulation/instrumentation , Assisted Circulation/methods , COVID-19/complications , COVID-19/therapy , Cardiac Catheterization/methods , Humans , Male , Prone Position/physiology , Prosthesis Implantation/instrumentation , Prosthesis Implantation/methods , SARS-CoV-2/isolation & purification , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/physiopathology , Shock, Cardiogenic/etiology , Shock, Cardiogenic/physiopathology , Shock, Cardiogenic/surgery , Treatment Outcome
6.
J Stroke Cerebrovasc Dis ; 29(8): 104974, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-665314

ABSTRACT

Emerging evidence suggests that patients with coronavirus disease 2019 (COVID-19) are at risk of thromboembolic complications, including ischemic strokes. We present a case illustrating the value of CT perfusion to identify acute small subcortical infarcts in a patient with COVID-19 admitted to an intensive care unit for bilateral pneumonia and pulmonary embolism presenting with sudden right limb weakness.


Subject(s)
Betacoronavirus/isolation & purification , Brain Infarction/diagnostic imaging , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Perfusion Imaging/methods , Pneumonia, Viral/diagnosis , Thalamic Diseases/diagnostic imaging , Tomography, X-Ray Computed , Anticoagulants/therapeutic use , Antiviral Agents/therapeutic use , Brain Infarction/therapy , COVID-19 , COVID-19 Testing , Coronavirus Infections/drug therapy , Coronavirus Infections/therapy , Coronavirus Infections/virology , Diffusion Magnetic Resonance Imaging , Host Microbial Interactions , Humans , Male , Middle Aged , Noninvasive Ventilation , Pandemics , Pneumonia, Viral/therapy , Pneumonia, Viral/virology , Predictive Value of Tests , Prosthesis Implantation/instrumentation , SARS-CoV-2 , Thalamic Diseases/therapy , Treatment Outcome , Vena Cava Filters
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