Implantation of cardiac electronic devices in active COVID-19 patients: Results from an international survey

Heart Rhythm. 2022 Feb;19(2):206-216. doi: 10.1016/j.hrthm.2021.10.020. Epub 2021 Oct 26.

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.

Keywords: Active COVID-19; Cardiac implantable electronic device procedure; Complications; Mortality; Personal protective equipment.

MeSH terms

  • 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
  • SARS-CoV-2 / isolation & purification*
  • Sick Sinus Syndrome* / epidemiology
  • Sick Sinus Syndrome* / therapy
  • Surveys and Questionnaires