Objectives:

Because of significant increases in the intensive care unit resources utilization due to the COVID-19 pandemic, the number of planned implantation of cardiac implantable electronic devices (CIEDs) has decreased.  As well, many of elective surgeries such as hip replacements have been postponed. During this period of reorganisation, a number of CIED implantations were therefore put “on hold”. The current investigation reports on the course of in hospital CIEDs implantations in Germany during the COVID-19 pandemic period compared with the pre-pandemic period. 

Methods:

For this investigation, the number of first-time device implantations or device replacements were analysed for pacemaker, implantable cardioverter/defibrillator (ICD), and CIEDs capable of cardiac resynchronisation therapy (CRT) for the period January – September 2020 and 2019. The number of monthly in-hospital CIED implantations were retrieved from the Data Browser of the “Institut für das Entgeltsystem im Krankenhaus” (InEK). We used the German Operation and Procedure Classification (OPS) codes to identify the relevant CIEDs implantation data.

Results:

The course of the pandemic situation in Germany in 2020 is displayed in Figure 1. Figure 2 highlights the percentage of total CIEDs implantations in 2020 compared with 2019. A clear decline is demonstrated from March to May. As an example of the characteristics of CIED-therapy, Figure 3 displays the numbers for CRT devices. Of note, the lines of 2019 and 2020 intersect between May and June, and the implantation rates continue to be greater than those observed in 2019 until September 2020. 

Discussion:

The present study shows the development of CIED implantation in Germany during the first three quarters of 2020 and compares the findings with the same period in 2019. A clear decline is seen in April after the government decision to postpone in-hospital elective procedures and treatments. The maximum decreased was observed in April at -22.95%, which corresponds to nearly every fourth implantation being postponed. Thereafter, the number of implantations steadily increased, reaching a maximum in June (+14.48%) and July (+14.27%). Similarly, especially when looking at very important and life-saving therapies such as CRT, the number of implantations declined in April but improved very quickly and remained superior to those of the 2019 until the end of the study period. These findings are in contrast with those observed for urgent interventions, e.g. for acute myocardial infarction which decreased at the beginning of the pandemic and stabilized at approximately the levels of 2019. In conclusion, a differential pattern of medical resource utilization was found during the COVID-19 pandemic with a catch-up effect observed only for CIED implantation.

Figure 2: Comparison of the monthly % changes of CIED implantations in 2020 compared