Abstract
Aims: Our objective was to determine the ventricular arrhythmia burden in implantable cardioverter-defibrillator (ICD) patients during COVID-19.
Methods and results: In this multicentre, observational, cohort study over a 100-day period during the COVID-19 pandemic in the USA, we assessed ventricular arrhythmias in ICD patients from 20 centres in 13 states, via remote monitoring. Comparison was via a 100-day control period (late 2019) and seasonal control period (early 2019). The primary outcome was the impact of COVID-19 on ventricular arrhythmia burden. The secondary outcome was correlation with COVID-19 incidence. During the COVID-19 period, 5963 ICD patients underwent remote monitoring, with 16 942 episodes of treated ventricular arrhythmias (2.8 events per 100 patient-days). Ventricular arrhythmia burden progressively declined during COVID-19 (P < 0.001). The proportion of patients with ventricular arrhythmias amongst the high COVID-19 incidence states was significantly reduced compared with those in low incidence states [odds ratio 0.61, 95% confidence interval (CI) 0.54-0.69, P < 0.001]. Comparing patients remotely monitored during both COVID-19 and control periods (n = 2458), significantly fewer ventricular arrhythmias occurred during COVID-19 [incident rate ratio (IRR) 0.68, 95% CI 0.58-0.79, P < 0.001]. This difference persisted when comparing the 1719 patients monitored during both the COVID-19 and seasonal control periods (IRR 0.69, 95% CI 0.56-0.85, P < 0.001).
Conclusions: During COVID-19, there was a 32% reduction in ventricular arrhythmias needing device therapies, coinciding with measures of social isolation. There was a 39% reduction in the proportion of patients with ventricular arrhythmias in states with higher COVID-19 incidence. These findings highlight the potential role of real-life stressors in ventricular arrhythmia burden in individuals with ICDs.
Trial registration: Australian New Zealand Clinical Trial Registry; URL: https://www.anzctr.org.au/; Unique Identifier: ACTRN12620000641998.
Keywords: COVID-19; Implantable cardioverter-defibrillator; Remote monitoring; Ventricular arrhythmia; Ventricular fibrillation; Ventricular tachycardia.
【저자키워드】 COVID-19, remote monitoring, ventricular arrhythmia, ventricular fibrillation, Implantable cardioverter-defibrillator, Ventricular tachycardia., 【초록키워드】 COVID-19 pandemic, social isolation, cohort study, arrhythmia, clinical, Patient, ICD, remote, multicentre, incidence, USA, correlation, Therapies, ventricular tachycardia, COVID-19 incidence, Stressor, Primary outcome, 95% CI, 95% confidence interval, individual, measure, secondary outcome, event, highlight, occurred, significantly, proportion, reduced, treated, determine, reduction in, New, declined, ventricular, with COVID-19, 【제목키워드】 coronavirus disease, pandemic,