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.