INTRODUCTION
The on-going pandemic of coronavirus disease 2019 (COVID-19) has created
a worldwide emergency:1 on March 8th, Italy became the
second most affected country in the world after China, and specific
rules for restricting social contacts in the whole country were applied
by the Italian Government in order to contain the epidemic spread. These
emergency measures were in force until May 4th, 2020.
At the end of June 2020, 240.000 cases were registered in Italy with
more than 34.000 deaths.2
As restrictions included the reduction or the interruption of several
routine public health and hospital services, as out-patient clinics and
office visits and routine hospital admissions for chronic disease, there
was widespread major concern regarding also the management of non-COVID
patients, such as patients with advanced cardiac disease, and its
prognostic implications during the lockdown period.
Recently a significant reduction of 47% in diagnosis of new-onset cases
of atrial fibrillation (AF) was observed in the danish adult population
during national lockdown in Denmark, suggesting that the risk of
complications of non-diagnosed AF could rise significantly and influence
the outcome unfavourably3. Furthermore an increase of
admissions to emergency department caused by rhythm disturbances has ben
recently observed in our region during lockdown period, despite a
reduction in dysrhythmia-related urgent unplanned
hospitalization4.
The aim of our study was to evaluate the risk of clinically relevant
cardiac arrhythmias during lockdown period in a study population with
advanced cardiac disease and high risk of cardiac arrhythmias and
mortality. In particular, we studied the impact of lockdown restrictions
on the incidence of new onset of AF and ventricular tachycardia (VT) and
fibrillation (VF) in patients with Implantable
cardioverter-defibrillators (AICD) and Cardiac Resynchronization
Therapy-defibrillators (ICD/CRT-Ds) for primary and secondary prevention
of sudden cardiac death.