Table 1.

Indications to EP procedures at the time of COVID-19 pandemia

Urgent procedures—always performed

➢ Ablation of drug-refractory electrical storms ➢ Ablation of life-threatening drug-refractory SVA ➢ Ablation of WPW syndrome or pre-excited AF with syncope or cardiac arrest ➢ Secondary prevention ICD implant ➢ PM implant in symptomatic AVB (3rd degree or Mobitz II) or SND with long pauses ➢ CIED replacement in end-of-life status in patients PM-dependent or with appropriate ICD shocks ➢ Lead/device revision for malfunctioning in patients PM-dependent or with appropriate ICD shocks ➢ Lead/device extraction for infections (endocarditis, sepsis, pocket infection) ➢ EMB for fulminant myocarditis ➢ ECV for life-threatening or symptomatic drug-refractory SVA ➢ TEE for urgent ECV

Semi-urgent procedures―performed in selected cases

➢ Ablation of drug-refractory recurrent VT ➢ Ablation of PVC and SVA in drug-refractory symptomatic patients ➢ Primary prevention CIED implant in high-risk patients ➢ CIED replacement in end-of-life status

Non-urgent procedures—never performed

➢ Ablation of PVC and SVA in stable patients ➢ PVS for risk stratification ➢ Primary prevention CIED implant in stable patients ➢ CIED replacement with > 6 weeks of battery remaining ➢ Extraction of non-infected leads/devices in a good functional status ➢ ECV for stable and well-tolerated arrhythmias ➢ LAA closure in patients who can be on oral anticoagulants ➢ TEE for routine assessment of valves/LAA closure devices, or for non-urgent ECV ➢ ILR implant* ➢ EMB for non-fulminant myocarditis* ➢ Tilt-table testing ➢ MRI exams

EP procedures performed at our institution are shown. Following the COVID-19 pandemic outbreak, indications were rapidly modified to comply with the ongoing healthcare emergency

*Isolated exceptions occurred, as described in detail in the main text

AF atrial fibrillation; AVB atrioventricular block; CIED cardiac implantable electronic devices; ECV electrical cardioversion; EMB endomyocardial biopsy; ICD implantable cardioverter defibrillator; ILR implantable loop recorder; LAA left atrial appendage; MRI magnetic resonance imaging; PM pacemaker; PVC premature ventricular complexes; PVS programmed ventricular stimulation; SND sinus node disease; SVA supraventricular arrhythmias; TEE transesophageal echocardiogram; VT ventricular tachycardia; WPW Wolff-Parkinson-White