Table 1.
Study characteristics.
| References | Country | Type of study | Type of procedure mentioned | PreCOVID-19 procedure volume | Procedures during COVID-19 | Overall reduction (%) | PostCOVID-19 procedure volume | Summary |
|---|---|---|---|---|---|---|---|---|
| Sulaiman et al.10 | Oman | Retrospective cohort | EPS | Not reported | Not reported | 50 | Not reported | Overall 35% reduction in catheterization lab procedures and 50% reduction in EP procedures |
| Anca et al.4 | USA | Retrospective cohort | CIED placement EPS |
426 | 115 | 73 | Not reported | EP laboratories in the hot spot areas, with a significant number of COVID-19 positive patients, have had to adapt. 14 EP procedures were reduced to many fold during the pandemic |
| Boriani et al .11 | Italy | Retrospective cohort | CIED placement EPS |
Not reported | Not reported | >50% for PPM >50% for ICD >50% for EPS |
Not reported | In this period a reduction of >50% in the number of implants of cardiac electronic devices was reported, and involved pacemakers and ICDs, with an important reduction not only on ICD implants for primary prevention of sudden death, but also on ICD implants for secondary prevention. The number of ablation procedures was markedly reduced and the reduction also affected emergency procedures, especially for centers directly involved in the care of COVID-19 |
| Compagnucci et al. 12 | Italy | Retrospective cohort | CIED placement EPS |
592 | 100 | 83.1 | Not reported | The data reinforce the concept that COVID-19 can have major direct as well as indirect effects on the practice of electrophysiology |
| Elliot13 | New Zealand | Retrospective cohort | CIED | 127 | 114 | 10.2 | Not reported | The fall in total EP procedures was largely due to reduced elective volumes. The number of in-patient EP procedures has remained relatively constant throughout the lockdown |
| Fersia et al. 14 | UK | Retrospective cohort | CIED | 71 | 28 | 60.5 | Not reported | This UK single-center experience showed that the COVID-19 pandemic has led to a significant reduction in all sections of cardiology service, particularly the intracardiac devices and EP procedures |
| Li et al. 15 | Multicenter (Italy, UK, China) | Retrospective cohort | CIED EPS VT/AF ablation |
Milan (Italy): 26.3 week London (UK): 15.1 week Wenzhou (China): 25.3 |
All centers: 0.85 week | Milan (Italy): 96.7London (UK): 94.3 Wenzhou (China): 96.6 |
Wenzhou (China): 20.6 week | Interventional electrophysiology is vulnerable to closure in times of great social difficulty including the COVID-19 pandemic. Intense public health intervention can permit suppression of local disease transmission allowing resumption of some normal activity with stringent precautions |
| Mazzone et al. 16 | Italy | Retrospective cohort | CIED EPS VT/AF ablation Lead extraction LAAC |
953 | 79 | 91.7 | Not reported | Only urgent EP procedures, including ventricular tachycardia ablation and extraction of infected devices, were both maintained and optimized to meet the needs of external hospitals. In addition, most of the nonurgent EP procedures were postponed. Finally, following prompt internal reorganization, both out-patient clinics and on-call services underwent significant modification, by integrating telemedicine support whenever applicable |
| Pothineni et al. 17 | USA | Retrospective cohort | CIED EPS VT/AF ablation |
EPS: 781 CIED: 896 |
EPS: 158 CIED: 475 |
EPS: 80 CIED: 47 VT: 59 AF: 83 |
Not reported | A strong inverse relationship between regional EP procedure volume and the surge in COVID-19 cases was observed. In addition to physician practice variations, patient avoidance of medical care may have also affected EP case volume similar to the reduction seen in ST-elevation myocardial infarction interventions |
| Rao et al. 18 | USA | Retrospective cohort | EPS | 380 | 68 | 82 | Not reported | Same-day discharge after PCI, pacemakers, ICDs, and routine ablation was encouraged. These have been shown to be safe, preferred by patients, and cost saving. Adoption of 7-day a week model facilitated capability to perform all necessary procedures even on the weekend and reduce length of stay |
| Satomi et al. 19 | Japan | Retrospective cohort | CIED EPS |
EPS: 4318 CIED: 1832 |
EPS: 3671 CIED: 1550 |
EPS: 8CIED: 15.3 | EPS: 4638 CIED: 1570 |
Physicians should determine the indication for an elective EP procedure while considering three principle factors: (1) the regional burden of the COVID-19 pandemic, (2) the PPE supply level, and (3) severity of the arrhythmias |
| Shahabi et al. 20 | Iran | Cross-sectional survey | CIED EPS |
EPS: 55 CIED: 48 |
EPS: 11 CIED: 10 |
CIED and EPS: 80 | Not reported | Based on the results of the present study and other surveys, COVID-19 pandemic decreased the numbers of referred patients with cardiac problems for EPS or intracardiac device implantation to hospitals as patients/medical staff fearing to infect of COVID-19 and/or low willingness of the healthcare system to provide these services |
| Ali21 | Pakistan | Retrospective cohort | CIED | 250 | 168 | 32.8 | Not reported | A marked reduction in the number of patients who presented for emergency intra cardiac devices and PPM procedures was seen during COVID-19 lockdown. The patients who presented from outside the city of the hospital and women in rural setting were significantly more effected |
| Arbelo et al. 22 | Spain | Retrospective cohort | CIED | 250 month | 131 month | 56.5 | Not reported | During the first wave of the COVID-19 pandemic, a substantial decrease in CIED implantations was observed in Catalonia |
| Bechlioulis23 | Greece | Retrospective cohort | CIED | Before first lockdown: 70 Before second lockdown: 146 |
After first lockdown: 56 After second lockdown: 50 |
First lockdown: 20Second lockdown: 65.7 | Not reported | It is evident that during the first wave of COVID-19 pandemic (February 2020–April 2020) a marked decrease of hospital visits and admissions for EP procedures were noted, although emergency pacemaker implantations were not significantly affected in many centers |
| Budrejko et al. 24 | Poland | Retrospective cohort | CIED EPS |
932 | 971 | 4increase | Not reported | Effort made to restore and further sustain the numbers of electrotherapy procedures throughout the first pandemic year, brought a result that only a few would have predicted in early 2020, that is the maintenance of high volume in most electrotherapy procedures, as supported by the above analysis |
| Konig25 | Germany | Retrospective cohort | CIED EPS |
CIED: 5826 EPS: 4481 |
CIED: 5391 EPS: 4039 |
CIED: 7EPS: 10 | Not reported | A significant performance deficit for all studied cardiovascular interventions was found in this study |
| Pescariu et al. 26 | Romania | Retrospective cohort | CIED | Not reported | Not reported | DM: 81.8Non-DM: 79.3 | Not reported | COVID-19 pandemic determined a dramatic decrease of intracardiac devices related procedures, which were mostly limited to emergency pacemaker implantations. Diabetic patients which are predisposed to develop dilated cardiomyopathy and/or cardiac arrhythmias, requiring more frequently and at a younger age therapy based on intracardiac devices, were particularly affected by the reduction of elective cardiovascular procedures during the COVID-19 pandemic, and that, because of the fear of infection with SARS-CoV-2 virus, they avoided medical services and/or ignored their symptoms |
| Sezenoz27 | Turkey | Retrospective cohort | CIED EPS |
CIED: 762 EPS: not reported |
CIED: 677 EPS: Not reported |
CIED: 11.1EPS: 22.2 | Not reported | The study showed that the EP procedures were significantly affected by the outbreak. The pandemic created an unprecedented clinical scenario |
| Wranicz et al. 28 | Poland | Retrospective cohort | CIED EPS |
841 | 742 | 11.7 | Not reported | The total number of selected electrotherapy procedures in the first quarter of 2020 was similar to the quarterly mean value for 2019 (742 vs. 841. Conversely, the number of procedures performed in the second quarter of 2020 was lower than the quarterly mean value for 2019 |
| Ferrari et al. 29 | Italy | Retrospective cohort | CIED | 42 | 9 | 80 | Not reported | The impact of COVID-19 on the number of procedures performed has been dramatic: there was a reduction of about 80% during the first semester of 2020 if compared to 2019 |
| Barbhaiya et al. 30 | USA | Retrospective cohort | AF ablation | 200 | 111 | 44.5 | Not reported | There was marked reduction of AF ablations in COVID-19 era and the findings demonstrate the feasibility of safe resumption of complex electrophysiology procedures during the COVID-19 pandemic, reducing healthcare utilization and maintaining quality of care |
| Ding et al. 31 | UK | Retrospective cohort | EPS | Not reported | Not reported | 52.2 | Not reported | The COVID-19 pandemic has had a significant impact on EP services at specialist centers in the UK. The number of procedures performed was greatly reduced in the initial period with latter improvements as better coping strategies were developed. However, the waiting lists for both EP and device procedures have continued to rise steadily |
CIED, cardiac implantable electronic device; COVID-19, coronavirus disease 2019; EP, Electrophysiology; EPS, electrophysiology studies; SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2.