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.