key: cord-0713001-7ra236tc authors: Satomi, Kazuhiro; Watanabe, Eiichi; Takatsuki, Seiji; Fukamizu, Seiji; Iwasaki, Yu‐ki; Takeuchi, Daiji; Nogami, Akihiko title: Statement for electrophysiological procedures under the COVID‐19 pandemic from the Japanese heart rhythm society task force date: 2020-09-07 journal: J Arrhythm DOI: 10.1002/joa3.12419 sha: 9d71f7a18b207b76e12a4fe0c38eea2874d5fd78 doc_id: 713001 cord_uid: 7ra236tc COVID‐19 is a global catastrophe with markedly reduced health and economy of human civilization. Heart rhythm disorder has also been impacted by this disease. This statement is the universal criteria for EP procedures in the new era, which we will face during COVID‐19 pandemic. We described the methods of triage based on the severity of disease, the regional state of pandemic and supply of medical resources. This guidance will be the universal criteria for EP procedures in the new era, which we will face during and after the COVID‐19 pandemic. The Japanese Heart Rhythm Society (JHRS) issued the first announcement on April 2, 2020. This announcement recommended the postponement of all elective electrophysiological (EP) procedures until the easement of the COVID-19 pandemic. This announcement aimed to preserve the medical resources, such as ICU beds and personal protective equipment (PPE), and to avoid the exposure of patients and health care professionals to SARS-CoV-2. 4, 5 With the improvement in the number of infections and the health care system, the Japanese government lifted the state of emergency on May 25th. This has provided the opportunity to reintroduce the regular cardiovascular care in a progressive manner with appropriate safeguards. The purpose of this statement from the JHRS is to address the issues facing electrophysiologists and to provide standard indications for the regulation and advancement of EP procedures for health care professionals during and after the COVID-19 pandemic. A questionnaire was sent out to the 417 EP centers to elucidate the situation of the management of COVID-19 in the EP centers and shortage of medical resources, such as masks and surgical gowns. Google Forms was used for a web-based questionnaire investigation from May 11 to 18, 2020. The questionnaire included, 1) the number of catheter ablation and device implantation cases from June to April 2020, 2) the postponement and limitations of the daily practice of cardiology, 3) worsening cases during the postpone or limitations of EP procedures, 4) COVID-19 screening in EP centers, and 5) the shortage of PPE supplies. 6 The questionnaire results were obtained from 218 EP centers (52% of certificate EP training hospitals) from all over Japan. There was a regional difference in the number of procedures according to cases, but had regional difference, 2) worsening heart failure was observed in patients with atrial fibrillation after postponing their F I G U R E 1 The number of Ablation and device implantations in Japan (A) and each area (B) from January 2020 to April 2020 elective catheter ablation, 3) in-hospital PCR tests were only available in half of the EP centers, and 4) the PPE shortage is still serious even in the nonpandemic area in Japan. Physicians should determine the indication for an elective EP procedure while considering three principle factors: 1) the regional burden of the COVID-19 pandemic, 2) the PPE supply level, and 3) severity of the arrhythmias (Figure 2 ). The guidance of the Heart Rhythm Society stated that EP procedures should be triaged according to the severity of the disease. 7 This guidance recommends that the electrophysiologist decide the EP procedure according to the severity of the disease while considering the balance between the status of the pandemic and PPE supply level. This guidance will be the universal criteria for EP procedures in the new era, which we will face during and after the COVID-19 pandemic. • Prior to performing procedures in patients from both the in-and out-patient settings, screening for COVID-19 should be performed including an evaluation of the symptoms, physical examination, and history of contact with COVID-19 patients. • COVID testing (RT-PCR or rapid antigen test) is recommended in all patients with an understanding that there may be false negative results. It is also important to identify ahead of time and ensure there are sufficient standard PPE for the procedures, as hospital resources can diminish quickly. • Patients should wear masks during their hospital stay. A minimally invasive procedure with a shorter length of stay is preferable. • If the patient is not intubated, a mask is placed on the patient prior to transport and during procedure. • Transesophageal echocardiography has the potential risk of Currently, there is no absolute treatment for this virus and several new treatments are being studied in many ongoing trials. 8 We are still facing a future explosive increase in COVID-19 cases in Japan. On the other hand, we should continue providing a high standard of medical care for all heart rhythm disorders. We appreciate the special assistance from Mr Hitoshi Fujino for his support of the COVID-19 task force of the Japanese Heart Rhythm Society and thank Mr John Martin for linguistic revision. Authors declare no Conflict of Interests for this article. COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-up Coronavirus Disease (COVID-19) Situation Reports Labor and Welfare. Mapping the Coronavirus Disease The statement of device procedure in COVID-19 pandemic The statement of ablation procedure in COVID-19 pandemic The questionnaire investigation of the situation of EP centers during the COVID-19 pandemic in Japan Guidance for Cardiac Electrophysiology During the Coronavirus (COVID-19) Pandemic from the HRS COVID-19 Task Force; Electrophysiology Section of the ACC; and the Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology Pharmacological Agents Targeting Thromboinflammation in COVID-19: Review and Implications for Future Research Statement for electrophysiological procedures under the COVID-19 pandemic from the Japanese heart rhythm society task force