Ventricular arrhythmia burden during the coronavirus disease 2019 (COVID-19) pandemic. (16th December 2020)

• Record Type: Journal Article
• Authors: O'Shea, Catherine J; Thomas, Gijo; Middeldorp, Melissa E; Harper, Curtis; Elliott, Adrian D; Ray, Noemi; Lau, Dennis H; Campbell, Kevin; Sanders, Prashanthan
• Is Part Of: European heart journal. Volume 42:Number 5(2021)
• Page Start: 520
• Page End: 528
• Publication Date: 2020-12-16
• Subjects: COVID-19 -- Implantable cardioverter-defibrillator -- Ventricular arrhythmia -- Ventricular tachycardia -- Ventricular fibrillation -- Remote monitoring; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehaa893
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Aims: Our objective was to determine the ventricular arrhythmia burden in implantable cardioverter-defibrillator (ICD) patients during COVID-19. Methods and results: In this multicentre, observational, cohort study over a 100-day period during the COVID-19 pandemic in the USA, we assessed ventricular arrhythmias in ICD patients from 20 centres in 13 states, via remote monitoring. Comparison was via a 100-day control period (late 2019) and seasonal control period (early 2019). The primary outcome was the impact of COVID-19 on ventricular arrhythmia burden. The secondary outcome was correlation with COVID-19 incidence. During the COVID-19 period, 5963 ICD patients underwent remote monitoring, with 16 942 episodes of treated ventricular arrhythmias (2.8 events per 100 patient-days). Ventricular arrhythmia burden progressively declined during COVID-19 ( P < 0.001). The proportion of patients with ventricular arrhythmias amongst the high COVID-19 incidence states was significantly reduced compared with those in low incidence states [odds ratio 0.61, 95% confidence interval (CI) 0.54–0.69, P < 0.001]. Comparing patients remotely monitored during both COVID-19 and control periods ( n = 2458), significantly fewer ventricular arrhythmias occurred during COVID-19 [incident rate ratio (IRR) 0.68, 95% CI 0.58–0.79, P < 0.001]. This difference persisted when comparing the 1719 patients monitored during both the COVID-19 and seasonal control periods (IRR 0.69, 95% CI 0.56–0.85, P < 0.001). Conclusions: During COVID-19, there was a 32% reduction in ventricular arrhythmias needing device therapies, coinciding with measures of social isolation. There was a 39% reduction in the proportion of patients with ventricular arrhythmias in states with higher COVID-19 incidence. These findings highlight the potential role of real-life stressors in ventricular arrhythmia burden in individuals with ICDs. Trial registration: Australian New Zealand Clinical Trial Registry; URL: https://www.anzctr.org.au/ ; Unique Identifier: ACTRN12620000641998 Graphical Abstract: