Introduction: Coronavirus disease 2019 (COVID-19) has presented unparalled challenges to the management of patients with cardiac implantable electronic devices (CIED). The need to limit exposure to healthcare staff and patients has increased reliance on remote monitoring (RM). This study summarises the change in workload of a device clinic in a Tertiary centre required to completely eliminate all outpatient activity in response to COVID-19.
Methods: In person (IP) follow-ups, RM follow-ups and remote transmissions (RT) received per-month to our device clinic were reviewed from institutional databases and manufacturer remote transmission data. Data was reviewed for the six months before the cessation of outpatient activity in response to COVID-19 (Sept 2019-Feb 2020; pre COVID) and the two months afterwards (April-May 2019; during COVID). Data from March was excluded due to COVID-19 restrictions beginning mid-way through the month. Referrals for procedures from our clinic to other hospitals during COVID were reviewed. Data are expressed as median (range).
Results: Of the 3562 patients (PPM 1828 patients, CRT-P 326, ICD/CRT-D 1408) reviewed annually at our centre, enrolment on RM increased from 97.4% to 97.8% ICD/CRT-D, 16.0% to 19.6% CRT-P and 1.6% to 6.5% PPM pre COVID to during COVID. RM was provided to all patients who required review following CIED procedures or those with hardware or clinical issues. There was a 26.9% reduction in total CIED follow ups (1813 per month (1293-2000) pre COVID to 1326 (1299-1353) during COVID) with a 98.7% reduction in IP follow ups (1335 per month (865-1565) to 15 (13-17)) offset by a 63.9% increase in RM follow ups (800 per month (650-920) vs 1311 (1282-1340)). IP follow ups were only performed for urgent MRIs in patients with CIEDs. PPM follow ups decreased by 77% (661 per month (495-759) to 150 (123-177)) and CRT-P by 53% (105 per month (85-144) to 50 (49-50)) whereas ICD/CRT-D follow ups remained similar to pre COVID levels (922 per month (629-1034) vs 917 (912-922), 0.5% decrease). Remote transmissions increased by 55% (969 per month (586-1010) pre COVID to 1505 (1488-1522) during COVID) with substantial increases for PPMs (19 per month (9-27) to 172 (168-175), 803% increase) and CRT-Ps (10 per month (6-25) to 58 (57-58), 475% increase). ICD/CRT-D transmissions increased by 55.3% (495 per month (586-1010) to 760 (145-536). Twenty patients were referred from our clinic for CIED related procedures at other hospitals (17 generator replacements, two right ventricular lead replacements and 1 right ventricular lead repositioning).
Conclusions: COVID-19 resulted in an immediate increase in CIED follow ups performed via remote monitoring due to the rapid provision of transmitters and the inability to perform IP follow ups. Significant changes to device clinics will be required in the post COVID-19 era including the re-establishment of reduced IP follow ups and an increased utilisation of RM.