Ahlam Al Awadhi1, Fatima Alkindi2, Mohammed Ahmed Siddiqui3, Moutaz El Kadri1, Omar Al Falasi1, Mohammad Matar Almehairi2

1Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates, 2Tawam Hospital, Al Ain, United Arab Emirates, 3Al Ain Hospital, Al Ain, United Arab Emirates

Background:
COVID-19 pandemic affected significantly elective procedures of various specialties including cardiology and electrophysiology. In addition, myocardial ischemia, myocarditis, arrhythmia and cardiac arrest were well-recognized cardiac complications of COVID-19 infection. Majority of cardiac arrhythmias associated with COVID-19 infection were transient and insertion of cardiac device was rarely required. We aim to study the indications for cardiac implantable electronic device (CIED) implantation during COVID-19 pandemic with focus on clinical characteristics and outcomes of infected patients.

Method(s):
A retrospective chart review study was conducted in three hospitals with electrophysiology (EP) services in the Emirate of Abu Dhabi (Sheikh Khalifa Medical City (SKMC), Tawam Hospital and AlAin Hospital).  We included all patients who required insertion of CIED during the period of 1st March to 10th of August 2020. Data regarding patient’s demographic, clinical status, COVID-19 polymerase chain reaction (PCR) results and EP devices were collected and descriptive analysis was used.

Result(s):
59 patients who required device implantation during study period were included. Mean age was 62.5 years, majority were males 72.8%, and non-nationals 61%.  Number of patients per facility was as the following; 35 patients at SKMC hospital, 23 patients at Tawam Hospital and 1 patient at AlAin hospital. The majority of patients [49 (83%)] required urgent EP device implantation. The types of CIED devices were pacemaker (38.9%%), implantable cardioverter-defibrillator (ICD) (25.4%), CRT-D (8.5%), CRT-P (1.7%), pulse generator replacement (PGR) (15.3%), CRT upgrade (5.1%), ICD upgrade (1.7%), ILR (1.7%) and lead revision (1.7%). The total number of CIED device implantation was lowest during May and April months with three and eight procedures performed respectively, that correlated with the surge of COVID-19 cases in UAE. Four patients (6,7%) from the cohort had positive COVID-19 PCR test.  Interestingly, two male patients had severe COVID-19 pneumonia complicated by complete heart block (CHB) and they required insertion of permanent pacemakers. One female patient with positive COVID-19 test on screening and needed permanent pacemaker for incidental congenital CHB.  Brugada syndrome was diagnosed in one patient who presented with sudden cardiac arrest, and initial test was positive for COVID-19 despite negative radiological studies.  Also, ICD as secondary prevention was implanted in a patient presented with sustained ventricular tachycardia. He had radiological features of moderate COVID-19 disease despite negative PCR test and found to have post myocarditis cardiomyopathy.

Conclusion(s):
the EP device implantation service in three facilities were affected during April and May months and were mainly dedicated for urgent indications that concur with the international guidance from ACC/AHA. Two patients with severe COVID-19 pneumonia required permanent pacemaker insertion for CHB, one patient had incidental finding of congenital CHB, one patient diagnosed with brugada syndrome and had ICD insertion and one needed ICD as secondary prevention for post myocarditis cardiomyopathy.  Larger studies are needed to understand the mechanism of arrhythmogensis of COVID infection and potential therapeutic options.