INTRODUCTION
In January 31, 2020, the World Health Organization declared a public health emergency of international concern for the outbreak of the novel Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). The infection rapidly reached pandemic levels, with Veneto and Lombardy being the first Italian Regions to be heavily affected. The steep increasing number of coronavirus disease 2019 (COVID-19) cases led the Italian Government to issue executive orders for virus containment on a national level in March 11. By that date, patients with a confirmed diagnosis of COVID-19 were about 225.000 in Italy and 7.800 in Lazio, of which one third were in Rome (1). On a public health perspective, while COVID-19 patients requiring professional care were congesting the hospitals, a reorganization of healthcare service delivery, mostly non-urgent or non-emergent ones, was deemed necessary. Yet, early efforts were made to secure an efficient and safe elective patient care (e.g., social distancing, mobility restrictions, use of personal protective equipment).
Over the last decade, remote monitoring (RM) system has profoundly transformed the standard of care for patients with cardiac electronic implantable devices (CIEDs). RM provides access to the same information of an in-person evaluation (IPE) via data transmission from CIEDs to dedicated platforms easily accessible by medical staff. Mounting evidence has confirmed its usefulness for early detection of atrial and ventricular arrhythmias, as well as monitoring of system performance [e.g., lead failure and battery depletion (2-5)]. Additional benefits were also demonstrated among heart failure (HF) patients in terms of preventing unfavourable cardiovascular events and reducing hospital readmissions (6-10).
In line with the recently issued Heart Rhythm Society indications (11), our Cardiac Electrophysiology and Stimulation Center (CESC) revised the pre-existing workflow for CIED patients. The cornerstone of the novel management protocol was the improvement of RM coverage in order to prevent any potential risk of exposure for patients and healthcare providers, without jeopardizing quality of care. The purpose of the present study was to report the efficacy and patient satisfaction with the new CIED management protocol adopted during COVID-19 Italian lockdown.