Abstract
Background: National authorities have introduced measures as lockdowns against spreading of COVID-19 and documented incidences of multiple non-COVID-19 diseases have dropped. Yet, data on workload dynamics concerning atrial fibrillation and electrical cardioversion whilst a national lockdown are scarce and may assist in future planning.Methods: Documented cases of atrial fibrillation and respective electrical cardioversion episodes at the Emergency Department of the Medical University of Vienna, Austria, from 01/01/2020 to 31/05/2020 were assessed. As reference groups, those incidences were calculated for the years 2017, 2018, and 2019. Inter- and intra-year analyses were conducted through Chi-square test and Poisson regression.Results: A total of 2,310 atrial fibrillation-, and 511 electrical cardioversion episodes were included. We found no significant incidence differences in inter-year analyses of the time periods from January to May, or of the weeks pre- and post the national lockdown due to the COVID-19 pandemic. However, the intra-year analysis of the year 2020 showed a trend toward decreased atrial fibrillation incidences (rate-ratio 0.982, CI 0.964–1.001, p = 0.060), and significantly increased electrical cardioversion incidences in the post-lockdown period (rate ratio 1.051, CI 1.008–10.96, p = 0.020).Conclusion: The decreased atrial fibrillation incidences are in line with international data. However, an increased demand of electrical cardioversions during the lockdown period was observed. A higher threshold to seek medical attention may produce a selected group with potentially more severe clinical courses. In addition, lifestyle modifications during isolation and a higher stress level may promote atrial fibrillation episodes to be refractory to other therapeutic approaches than electrical cardioversion.
Highlights
During the ongoing corona virus disease 2019 (COVID-19) pandemic, national authorities have introduced measures to control the outbreak and avoid overloading already-strained healthcare resources such as intensive care units [1,2,3,4]
In the observational periods of January to May 2017, 2018, 2019, and 2020, a total of 2310 atrial fibrillation (AF) episodes were noted, of which 511 episodes (22.1%) necessitated electrical cardioversion. This leads to an average of 116 AF episodes and 26 electrical cardioversions per month
Thereby, similar results could be shown for the therapeutic approach of electrical cardioversion (eCV) (130 vs. 133 vs. 120 vs. 128 episodes, respectively, p = 0.479)
Summary
During the ongoing corona virus disease 2019 (COVID-19) pandemic, national authorities have introduced measures to control the outbreak and avoid overloading already-strained healthcare resources such as intensive care units [1,2,3,4]. Following recommendations by the World Health Organization [5], the response in Austria was local distancing, quarantines and a general public lockdown, starting in mid-March 2020. These precautionary measures have been extensively communicated through media, with information reaching a high percentage of the population. National authorities have introduced measures as lockdowns against spreading of COVID-19 and documented incidences of multiple non-COVID-19 diseases have dropped. Data on workload dynamics concerning atrial fibrillation and electrical cardioversion whilst a national lockdown are scarce and may assist in future planning
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