Indications for Procedures from the Outpatient Setting
As per the recent consensus statement from the Heart Rhythm Society,
American Heart Association and American College of Cardiology, only
urgent and emergent procedures were performed during the current upswing
of the COVID-19 infection curve in order to minimize virus transmission
between patients and providers.7 Emergent procedures
according to clinical discretion may include cardioversion, implantation
of temporary or permanent pacemaker (PPM), or ablation for arrhythmias
refractory to medical management. The goal is to reduce non-urgent
person-to-person interactions. “Elective” cases that ultimately may be
life-prolonging or symptom-relieving have been delayed, since incidental
and unpredictable infection with COVID-19 in a stable out-patient would
be regrettable and harmful. As of March 16, NYPH suspended elective
cases in order to concentrate equipment, supplies, and providers on
responding to the COVID-19 public health crisis.
Elective cases have consisted of routine ablations for paroxysmal
supraventricular tachycardia (SVT), atrial fibrillation (AF), premature
ventricular contractions (PVCs) or ventricular tachycardia (VT) and
device implant procedures such as primary-prevention internal
cardioverter defibrillator (ICD), PPM for sinus node dysfunction with
stable rhythm or asymptomatic 2:1 atrioventricular block (AVB), cardiac
resynchronization therapy (CRT) or upgrade, as well as cardioversion for
symptomatic AF and loop recorder implantation. Patients with cancelled
elective procedures have been followed with weekly check-ins and use of
telehealth services as needed to reevaluate their clinical status.
Deferment of elective cases have been rationalized to patients either by
phone or telemedicine visit, and during these communications health care
providers ensure patients have sufficient medication to manage their
arrhythmias for at least 3 months or longer.