Due to the unpredictable course of the COVID-19-pandemic and the concern to exceed the capacities of high care hospital beds, many scheduled elective interventions, amongst others rhythmological procedures, were deferred. However, the effect of this measure on patients suffering from heart rhythm disorders has not been evaluated, yet.
Purpose:
The aim of this study was to explore the consequences of deferral on outcomes of heart rhythm patients.
Methods:
Patients suffering from heart rhythm disorders whose scheduled elective rhythmological intervention (invasive rhythmological procedures, pacemaker- and ICD-implantations including upgrades and revisions) had been deferred between March 19th and April 30th 2020 were eligible for inclusion (study group). Patients who underwent such a rhythmological procedure between March 19th and April 30th 2019 served as the control group. The primary endpoint was the time to emergency cardiovascular hospitalization or death. Secondary endpoints were clinical parameters such as symptoms as measured by EHRA classification, serum levels of cardiac biomarkers, as well as left ventricular systolic function.
Results:
In total outcomes of 55 consecutive patients whose rhythmological intervention had been deferred and 57 patients who underwent the procedure as planned, were compared. Intriguingly, the primary endpoint was significantly increased in patients whose scheduled intervention had been deferred (HR 2.38; 95% CI 1.06-5.36; p=0.031). Clinical symptoms, as measured by EHRA-class, did not differ significantly at baseline between both groups, but were significantly higher after 12 months of follow-up in the study group (study group mean EHRA-class 1.2±0.5; control group: 1.1±0.4, p=0.003).
Conclusion:
Our results suggest that deferral of scheduled elective rhythmological procedures is associated with worse clinical outcomes as indicated by the higher rate of emergency cardiovascular hospitalizations and increase in symptoms. As a consequence, the potential benefits and harms of deferring rhythmological procedures should be carefully balanced.
https://dgk.org/kongress_programme/ht2021/P91.htm