Background

Infection with the SARS-CoV-2 virus has led to a world-wide pandemic situation (COVID-19) taking millions of lives. Cardiovascular disease has been reported to be an independent risk factor for potentially severe clinical course of COVID-19. Further, myocardial injury can occur during COVID-19 infection with an unknown risk of malignant arrhythmias. With growing infection rates in Italy, a similarly rising number of out-of-hospital cardiac arrests have been noticed. To date, the incidence, and clinical circumstances of ventricular arrhythmias (VA) during COVID-19 pandemic are unknown.

Objective

To evaluate the incidence and clinical circumstances of VA during the COVID-19 pandemic in patients with cardiac implanted electrical devices (CIED).

Methods

We analysed a total of 100 CIED patients who had documented ventricular arrhythmias (VA) during December 2019-May 2020. A group of 45 ICD-patients continuously surveyed by Abbott/Merlin.net home monitoring database and their respective documented VA during December 2018-May 2019 (12 months before) served as a control group.

Results

Patients with documented VA during the COVID-19 pandemic had a mean age of 70 (±13) years (p=0.007) and were mostly male (n=83; 83%). The majority of these patients had a primary preventive indication for ICD-therapy (n=43; 43%) and 68 patients (68%) had 25 single chamber ICDs, 18 dual chamber ICDs, 24 CRT-Ds and one S-ICD. 32 patients (32%) had single- or dual-chamber pacemakers. During December 2019 to May 2020, 79 patients experienced non-sustained VT, 16 patients sustained VT, 2 patients VF and 3 patients VT degenerating to VF (p<0.001) (figure). In 18 patients ICD-therapy (ATP, shock or both) were necessary to terminate the sustained VA, in three pacemaker patients the documented sustained VTs were self-terminating but causing symptoms. The calculated incidence of VA was 16.7% and numerically 5.7% higher compared to the control group (p<0.001).  Most patients (89%) were treated with heart failure medication and 23% were on ARNI. During this short follow-up period of 6 months all respective patients remained alive.

Conclusion

This retrospective single-center observational study reports a significant higher incidence of ventricular arrhythmias during the pandemic with the novel SARS-CoV2-virus in patients with cardiovascular disease and CIED in comparison to a historic control-group of ICD-patients followed by remote-monitoring 12 months before. Further scientific evidence is urgently warranted to elucidate immediate and long-term myocardial affection of COVID-19 disease in cardiac patients.