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Ventricular arrhythmia burden during the coronavirus disease 2019 (COVID-19) pandemic
Catherine J O'Shea1,2, Gijo Thomas1, Melissa E Middeldorp1,2
1Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia.
Insights
During COVID-19, implantable cardioverter-defibrillator patients experienced a significant reduction in ventricular arrhythmias. Social isolation measures correlated with decreased arrhythmia burden, suggesting a link between real-life stressors and cardiac events.
Area of Science:
- Cardiology
- Epidemiology
- Public Health
Background:
- The COVID-19 pandemic introduced unprecedented public health measures, including social isolation.
- Understanding the impact of these measures on cardiovascular health, particularly in patients with implantable cardioverter-defibrillators (ICDs), is crucial.
Purpose of the Study:
- To determine the burden of ventricular arrhythmias in ICD patients during the COVID-19 pandemic.
- To assess the correlation between COVID-19 incidence and ventricular arrhythmia burden.
Main Methods:
- A multicentre, observational cohort study involving 5963 ICD patients monitored remotely over 100 days during the COVID-19 pandemic.
- Comparison with a 100-day control period in late 2019 and a seasonal control period in early 2019.
- Analysis of ventricular arrhythmia episodes and correlation with COVID-19 incidence rates across different states.
Main Results:
- A progressive decline in ventricular arrhythmia burden was observed during the COVID-19 period (P < 0.001).
- A significant reduction in ventricular arrhythmias was noted in states with higher COVID-19 incidence compared to low incidence states (OR 0.61, P < 0.001).
- Fewer ventricular arrhythmias occurred during COVID-19 compared to control periods (IRR 0.68, P < 0.001).
Conclusions:
- A 32% reduction in device-treated ventricular arrhythmias coincided with social isolation measures during COVID-19.
- A 39% reduction in patients experiencing ventricular arrhythmias was observed in high COVID-19 incidence states.
- Real-life stressors may play a significant role in ventricular arrhythmia burden among individuals with ICDs.
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.
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