Urgent Pacemaker Implantation Rates in the Veneto Region of Italy After the COVID-19 Outbreak
2020; Lippincott Williams & Wilkins; Volume: 13; Issue: 6 Linguagem: Inglês
10.1161/circep.120.008722
ISSN1941-3149
AutoresFederico Migliore, Alessandro Zorzi, Darío Gregori, Alvise Del Monte, Pasquale Valerio Falzone, Roberto Verlato, Mariachiara Siciliano, Sakis Themistoclakis, P China, Domenico Marchese, Giampaolo Pasquetto, Barbara Ignatiuk, Carlo Cernetti, Enrico Giacomin, Vittorio Calzolari, Claudio Bilato, Chiara Dalla Valle, Gianfranco Frigo, Leonardo Marinaccio, Salvatore Saccà, Antonio Lupo, Loris Roncon, Lina Marcantoni, Alberto Tosi, Giovanni Turiano, Franco Folino, Martina Perazzolo Marra, Luisa Cacciavillani, Sabino Iliceto,
Tópico(s)Diverse Musicological Studies
ResumoHomeCirculation: Arrhythmia and ElectrophysiologyVol. 13, No. 6Urgent Pacemaker Implantation Rates in the Veneto Region of Italy After the COVID-19 Outbreak Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBUrgent Pacemaker Implantation Rates in the Veneto Region of Italy After the COVID-19 Outbreak Federico Migliore, Alessandro Zorzi, Dario Gregori, Alvise Del Monte, Pasquale Valerio Falzone, Roberto Verlato, Mariachiara Siciliano, Sakis Themistoclakis, Paolo China, Domenico Marchese, Giampaolo Pasquetto, Barbara Ignatiuk, Carlo Cernetti, Enrico Giacomin, Vittorio Calzolari, Claudio Bilato, Chiara Dalla Valle, Gianfranco Mario Frigo, Leonardo Marinaccio, Salvatore Saccà, Antonio Lupo, Loris Roncon, Lina Marcantoni, Alberto Tosi, Giovanni Turiano, Franco Folino, Martina Perazzolo Marra, Luisa Cacciavillani, Sabino Iliceto and on behalf of The Padua School of Cardiology Network Federico MiglioreFederico Migliore Correspondence to: Federico Migliore, MD, PhD, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani 2, 35121 Padova, Italy. Email E-mail Address: [email protected] https://orcid.org/0000-0001-8574-9421 Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.Z., D.G., A.D.M., P.V.F., F.F., M.P.M., L.C., S.I.). , Alessandro ZorziAlessandro Zorzi Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.Z., D.G., A.D.M., P.V.F., F.F., M.P.M., L.C., S.I.). , Dario GregoriDario Gregori https://orcid.org/0000-0001-7906-0580 Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.Z., D.G., A.D.M., P.V.F., F.F., M.P.M., L.C., S.I.). , Alvise Del MonteAlvise Del Monte Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.Z., D.G., A.D.M., P.V.F., F.F., M.P.M., L.C., S.I.). , Pasquale Valerio FalzonePasquale Valerio Falzone https://orcid.org/0000-0003-2752-5264 Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.Z., D.G., A.D.M., P.V.F., F.F., M.P.M., L.C., S.I.). , Roberto VerlatoRoberto Verlato https://orcid.org/0000-0002-9650-4507 Cardiology Division, Hospital of Cittadella, Italy (R.V., M.S., G.M.F.). Cardiology Division, Hospital of Camposampiero, Padova, Italy (R.V.). , Mariachiara SicilianoMariachiara Siciliano Cardiology Division, Hospital of Cittadella, Italy (R.V., M.S., G.M.F.). , Sakis ThemistoclakisSakis Themistoclakis Department of Cardiology, Dell′ Angelo Hospital, Mestre, Italy (S.T., P.C.). , Paolo ChinaPaolo China Department of Cardiology, Dell′ Angelo Hospital, Mestre, Italy (S.T., P.C.). , Domenico MarcheseDomenico Marchese https://orcid.org/0000-0003-3372-3662 Cardiology Division, Hospital of Piove di Sacco, Padova, Italy (D.M., L. Marinaccio). , Giampaolo PasquettoGiampaolo Pasquetto https://orcid.org/0000-0001-5955-5439 Division of Cardiology, Riuniti Hospital Padova Sud, Monselice, Italy (PD) (G.P., B.I.). , Barbara IgnatiukBarbara Ignatiuk https://orcid.org/0000-0001-6089-6644 Division of Cardiology, Riuniti Hospital Padova Sud, Monselice, Italy (PD) (G.P., B.I.). , Carlo CernettiCarlo Cernetti Department of Cardiology, Hospital of Treviso, Italy (C.C., E.G., V.C.). , Enrico GiacominEnrico Giacomin https://orcid.org/0000-0002-5636-6410 Department of Cardiology, Hospital of Treviso, Italy (C.C., E.G., V.C.). , Vittorio CalzolariVittorio Calzolari Department of Cardiology, Hospital of Treviso, Italy (C.C., E.G., V.C.). , Claudio BilatoClaudio Bilato Cardiologia, Ospedali dell'Ovest Vicentino, Azienda ULSS 8 Berica, Arzignano, Vicenza, Italy (C.B., C.D.V.). , Chiara Dalla ValleChiara Dalla Valle https://orcid.org/0000-0001-9043-1709 Cardiologia, Ospedali dell'Ovest Vicentino, Azienda ULSS 8 Berica, Arzignano, Vicenza, Italy (C.B., C.D.V.). , Gianfranco Mario FrigoGianfranco Mario Frigo Cardiology Division, Hospital of Cittadella, Italy (R.V., M.S., G.M.F.). , Leonardo MarinaccioLeonardo Marinaccio Cardiology Division, Hospital of Piove di Sacco, Padova, Italy (D.M., L. Marinaccio). , Salvatore SaccàSalvatore Saccà Cardiology Department, Public Hospital of Mirano, Venezia, Italy (S.S., A.L.). , Antonio LupoAntonio Lupo https://orcid.org/0000-0002-0131-3100 Cardiology Department, Public Hospital of Mirano, Venezia, Italy (S.S., A.L.). , Loris RonconLoris Roncon Cardiology Department, Arrhythmia & Electrophysiology Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy (L.R., L. Marcantoni). , Lina MarcantoniLina Marcantoni Cardiology Department, Arrhythmia & Electrophysiology Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy (L.R., L. Marcantoni). , Alberto TosiAlberto Tosi Department of Cardiology, Civil Hospital, Belluno, Italy (A.T., G.T.). , Giovanni TurianoGiovanni Turiano Department of Cardiology, Civil Hospital, Belluno, Italy (A.T., G.T.). , Franco FolinoFranco Folino https://orcid.org/0000-0003-1465-6329 Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.Z., D.G., A.D.M., P.V.F., F.F., M.P.M., L.C., S.I.). , Martina Perazzolo MarraMartina Perazzolo Marra Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.Z., D.G., A.D.M., P.V.F., F.F., M.P.M., L.C., S.I.). , Luisa CacciavillaniLuisa Cacciavillani Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.Z., D.G., A.D.M., P.V.F., F.F., M.P.M., L.C., S.I.). , Sabino IlicetoSabino Iliceto Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.Z., D.G., A.D.M., P.V.F., F.F., M.P.M., L.C., S.I.). and on behalf of The Padua School of Cardiology Network Originally published20 May 2020https://doi.org/10.1161/CIRCEP.120.008722Circulation: Arrhythmia and Electrophysiology. 2020;13:e008722Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: May 21, 2020: Ahead of Print On February 21, the first cases of severe acute respiratory syndrome coronavirus 2 infection were diagnosed in hospitalized patients in the Lombardy and Veneto regions of Italy. Immediately, the population was warned by public health authorities to avoid nonurgent visits to the emergency department. During the subsequent days, the number of people affected, and the number of hospital beds occupied by patients with coronavirus disease 2019 (COVID-19) increased exponentially. A lockdown was imposed by the Italian government on March 8. At the same time, the population was warned by public authorities not to misuse the emergency services due to the possible overload of hospital capacity and risk of infection.We reported the trends in urgent pacemaker implantations in 10 hospitals of the Veneto region of Italy during the six weeks before and after the COVID-19 outbreak started and during the corresponding 2019 period.The authors declare that all supporting data are available within the article. We evaluated the number of urgent pacemaker implantations in 10 different hospitals of the Veneto region during the 6 weeks before and after February 21, 2020 (day of the first COVID-19 diagnosis in Italy). We also evaluated the corresponding 12 weeks in 2019. Urgent pacemaker implantation was defined as the presence of symptomatic sinus dysfunction or atrioventricular conduction disturbance that required admission to the emergency department and pacemaker implantation within one week. To account for the reduced number of heart surgery and transcatheter aortic valve replacement interventions, we excluded pacemaker implantation for postprocedural atrioventricular block.In our region, patients evaluated in the outpatient setting that needs urgent pacemaker implantation must be admitted through the emergency department; those who were not deemed severe enough to require urgent admission were excluded.Data are presented as counts (%) or as median (first–third quartiles). Categorical variables were compared with the χ2 test while continuous data were compared using the the Mann-Whitney U test. Behavior of counts over time has been modeled using a loess function within a Conway-Maxwell Poisson regression allowing for time-induced overdispersion. Analyses were made with the R System X and the COMPoissonReg libraries X. The study was approved by the ethical committee. Because of the type of investigation, consent from patients was waived.The number of urgent pacemaker implantations (excluding postheart surgery or transcatheter aortic valve replacement atrioventricular blocks) during the 6 weeks before and after February 21, 2020 and during the corresponding period in 2019 are shown in the Figure. Compared with the 6 weeks before the first COVID-19 case, a significant decrease in the number of urgent pacemaker implantations was observed during the 6 weeks after (from 122 to 88, −28%; P=0.02). The decrease appeared particularly evident after the lockdown was imposed by the Italian government on March 8. In 2019, a similar number of pacemaker implantations were performed during the 6 weeks before February 21 compared with 2020 (119 versus 122, +3%; P=0.80). After this date, the number of pacemaker implantations in 2019 remained similar (123) while in 2020 it decreased to 88 (−29%; P=0.02).Download figureDownload PowerPointFigure. Urgent pacemaker implantations before and during the coronavirus disease 2019 (COVID-19) outbreak. Number of urgent pacemaker implantations (excluding post heart surgery and post trans-aortic valve implantation atrioventricular blocks) in 10 hospitals of the Veneto region of Italy during each of the 6 weeks before (dark color bars) and after (light color bars) the beginning of the COVID-19 outbreak on February 21, 2020 (A). Cumulative number of urgent pacemaker implantation during the 6 wk period before February 21, 2019 (pre 2019); before February 21, 2020 (pre 2020); after February 21, 2019 (post 2019); and after February 21, 2020 (post 2020; B).In 2020, the proportion of female patients requiring urgent pacemaker decreased after the COVID-19 outbreak from 60/122 (49%) to 30/88 (34%; P=0.03). There were no differences in terms of median age (81 [77–86] versus 82 [75–88], P=0.52), proportion of patients implanted for complete atrioventricular block (44% versus 50%, P=0.41), proportion of patients who presented for syncope (46% versus 53%, P=0.07) and proportion of patients who presented within 24 hours after symptom onset (52% versus 60%, P=0.18) between the 2 study periods.While cardiology societies are trying to answer the mystery of the missing ST-segment elevation myocardial infarctions during the COVID-19 pandemic, our research group found a reduction in urgent pacemaker implantation rates in the Veneto region of Italy. Although we may advance different hypothesis to explain this finding, we believe that the most likely explanation is that many people, fearing infection, may not seek medical attention even for severe symptoms. The proportion of patients who presented for syncope and within 24-hour after symptoms onset increased after the COVID-19 outbreak started, although the difference was not significant, while the proportion of women significantly decreased. This suggest that particularly patients with less symptomatic bradycardia refrained from seeking medical attention. According to our findings, this behavior appears more frequent among females. Thus, in the next weeks we may expect an increase in the number of patients who are suffering the consequences of this crisis and we may see several complications, including cardiogenic shock, caused by the delayed treatment of these patients. Finally, it is conceivable that part of the deaths occurring during this pandemic may be caused by the absence of otherwise routine medical care rather than COVID-19.Nonstandard Abbreviations and AcronymsCOVID-19coronavirus disease 2019Sources of FundingNone.DisclosuresNone.Footnotes*Drs Migliore and Zorzi contributed equally to this work.For Sources of Funding and Disclosures, see page 577.Correspondence to: Federico Migliore, MD, PhD, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani 2, 35121 Padova, Italy. Email federico.migliore@libero.it eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. 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Maines M, Zorzi A, Benetollo P, Guarrera G, Moz M, Manica A, Demattè C and Del Greco M (2020) Short-term outcome associated with remote evaluation (telecardiology) of patients with cardiovascular diseases during the COVID-19 pandemic, IJC Heart & Vasculature, 10.1016/j.ijcha.2020.100625, 30, (100625), Online publication date: 1-Oct-2020. June 2020Vol 13, Issue 6 Advertisement Article InformationMetrics © 2020 American Heart Association, Inc.https://doi.org/10.1161/CIRCEP.120.008722PMID: 32434373 Originally publishedMay 20, 2020 Keywordsatrioventricular blockbradycardiaCOVID-19pacemakerpandemicsPDF download Advertisement SubjectsArrhythmiasEpidemiologyHealth ServicesPacemaker
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