Rebooting atrial fibrillation ablation in the COVID-19 pandemic

Area of Science:

• Cardiology
• Electrophysiology
• Infectious Disease Epidemiology

Background:

• Catheter ablation for atrial fibrillation (AF) was significantly reduced during the COVID-19 pandemic due to resource conservation and exposure concerns.
• Limited data exists on the peri-procedural outcomes of medical procedures during the pandemic.
• Protocols were developed to safely restart AF ablation while minimizing healthcare resource use.

Purpose of the Study:

• To evaluate the acute and subacute outcomes of AF ablation performed under newly implemented COVID-19 protocols.
• To assess the safety and efficacy of restarting complex electrophysiology procedures during the pandemic.
• To determine the impact of new protocols on healthcare resource utilization.

Main Methods:

• A comparative analysis of patients undergoing AF ablation in 2020 (n=111) under COVID-19 protocols versus 2019 (n=200).
• Implementation of new practices: pre-procedure COVID-19 testing, selective transesophageal echocardiography (TEE), venous closure, and same-day discharge.
• Analysis of perioperative healthcare utilization and acute procedural outcomes.

Main Results:

• One out of 111 patients tested positive for COVID-19 pre-ablation; no ablation-related transmission or major complications occurred in either cohort.
• Significantly fewer patients in the 2020 cohort received pre-procedure TEE (68.4%) compared to the 2019 cohort (97.5%), despite a higher prevalence of persistent arrhythmia.
• Same-day discharge was achieved in 68% of the 2020 cohort versus 0% in the 2019 cohort.

Conclusions:

• The study demonstrates the feasibility of safely resuming complex electrophysiology procedures, such as AF ablation, during the COVID-19 pandemic.
• Instituted protocols effectively reduced healthcare utilization while maintaining the quality of care.
• These protocols may be adaptable to other procedures and healthcare settings.