SAFETY AND RESOURCE UTILIZATION
The primary population-level intervention to combat COVID-19 is social distancing. Slowing dissemination of SARS-CoV-2 has been challenging as an estimated 80% of infected individuals are asymptomatic or mildly symptomatic yet may still shed the virus.2 SARS-CoV-2 can survive on surfaces, particularly plastic and stainless steel, for up to 72 hours.3 Lack of widespread availability of accurate testing has complicated numerical estimates of cases. Minimizing exposure time to high-risk environments is essential. Family members and healthcare workers in close contact with infected individuals are high-risk groups.2 The 3 at-risk groups when considering invasive cardiac electrophysiology procedures are patients, the general population, and hospital personnel.
For patients without COVID-19, the potential benefit of a procedure must be balanced with additional interactions with hospital personnel and time in the hospital. Older age and co-existing medical conditions are associated with increased mortality risk and should be taken into consideration.2 Undiagnosed asymptomatic or minimally symptomatic hospital personnel with COVID-19 may still be working. While a goal of a procedure may be to shorten hospitalization time or to decrease the risk of rehospitalization, complications may markedly increase hospital stay and, consequently, infection risk. Acquisition of SARS-CoV-2 may also increase exposure to the general population after discharge.
Personnel within the cardiac electrophysiology laboratory should consult with their in-hospital infection prevention and control section for institution-specific considerations. The minimum number of personnel should be involved with patients with known or suspected COVID-19, and trainee participation is discouraged. All workers should be trained and fitted for personal protective equipment (PPE). N95 masks or powered air-purifying respirators are recommended for COVID-19 cases.9,10 PPE utilization must account for limited supplies that may be needed later for worst-case scenarios. Increasing availability of SARS-CoV-2 testing should allow more accurate stratification of PPE needs in the procedure planning phase. A major potential consequence of exposure to the cardiac electrophysiology team is that quarantine would make them temporarily unavailable.
Hospitals in geographical regions with a high prevalence of COVID-19, or “hot zones”, have reported shortages in PPE, intensive care unit beds, and mechanical ventilators. In these locations, the threshold to consider invasive cardiac electrophysiology procedures may increase even higher. Certain procedures may strain personnel and equipment from various sections. For example, catheter ablation for atrial fibrillation may involve anesthesia and cardiac imaging. Procedurally related adverse events that require intensive care unit monitoring and mechanical ventilation may jeopardize resources needed to treat COVID-19 patients, particularly if a local surge develops. As organizations have called for stoppage to elective procedures6-10, this may result in liability.