The Impact of the COVID-19 Pandemic on Cardiac Electrophysiology Training: A Survey Study.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has resulted in a significant decrease in volume of electrophysiology (EP) procedures. There has been concern that trainees may not achieve the procedural numbers required to graduate as independent electrophysiologists within the usual timeline. We sought to determine the impact of the COVID-19 pandemic on the percentage of clinical cardiac EP (CCEP) fellows in jeopardy of not meeting procedural volume requirements and overall sentiments regarding preparedness of fellows for independent practice. METHODS: We surveyed CCEP fellows and program directors about baseline procedural volumes, curriculum changes due to the pandemic, and attitudes about preparedness for board examinations and independent practice. RESULTS: Ninety-nine fellows and 27 program directors responded to the survey. Ninety-eight percent of responding fellows reported a decrease in procedural volume as a result of the pandemic. Program directors reported an overall decrease in annual number of ablations and device procedures performed by each fellow during the 2019-2020 academic year compared to the preceding year. Despite this, a minority of fellows and program directors reported concerns about meeting Accreditation Council for Graduate Medical Education procedural requirements for devices (9% and 4%, respectively) and ablation (19% and 9%) or preparedness for independent practice after a 2-year fellowship. CONCLUSIONS: The COVID-19 pandemic has resulted in a decrease in procedural volume for CCEP trainees, but the majority of fellows and program directors do not anticipate major barriers to timely graduation. This may change with COVID-19 resurgence and further interruptions in training.

Temporary transvenous cardiac pacing: a survey on current practice.

BACKGROUND: Temporary transvenous cardiac pacing (TTCP) is a standard procedure in current practice, despite limited coverage in consensus guidelines. However, many authors reported several complications associated with TTCP, especially development of infections of cardiac implantable electronic devices (CIED). The aim of this survey was to provide a country-wide picture of current practice regarding TTCP. METHODS: Data were collected using an online survey that was administered to members of the Italian Association of Arrhythmology and Cardiac Pacing. RESULTS: We collected data from 102 physicians, working in 81 Italian hospitals from 17/21 regions. Our data evidenced that different strategies are adopted in case of acute bradycardia with a tendency to limit TTCP mainly to advanced atrioventricular block. However, some centers reported a greater use in elective procedures. TTCP is usually performed by electrophysiologists or interventional cardiologists and, differently from previous reports, mainly by a femoral approach and with nonfloating catheters. We found high inhomogeneity regarding prevention of infections and thromboembolic complications and in post-TTCP management, associated with different TTCP volumes and a strategy for management of acute bradyarrhythmias. CONCLUSION: This survey evidenced a high inhomogeneity in the approaches adopted by Italian cardiologists for TTCP. Further studies are needed to explore if these divergences are associated with different long-term outcomes, especially incidence of CIED-related infections.

A Survey of Current Anesthesia Trends for Electrophysiology Procedures.

BACKGROUND: There has been a dramatic shift in recent years in anesthesia coverage for electrophysiology (EP) procedures. An anesthesiologist and electrophysiologist at our institution jointly developed a survey, which was distributed to the Society of Cardiovascular Anesthesiologists and the Heart Rhythm Society. Its goal was to document current practice patterns and examine perceived variability in coverage. METHODS: On approval of the leadership from the Society of Cardiovascular Anesthesiologists and the Heart Rhythm Society, an online survey was administered to the membership. The survey included demographic data, anesthetic type, and perceptions of the respondents. RESULTS: Four hundred seventy-nine surveys were completed. Thirty-eight percent were completed by electrophysiologists and 63% by anesthesiologists, giving a response rate of 8.24% for anesthesiologists and 13.6% for electrophysiologists. Of these, 57% of respondents worked in an academic setting. Over the past 2 years, 66.5% of respondents reported anesthesia involvement in EP cases increasing. These cases are reportedly covered by all anesthesiologists in a group 55% of the time, cardiac anesthesia 32.5%, and a designated team at the remainder of the institutions. Seventy-six percent of respondents reported having designated EP block time in the schedule. Ninety-two percent of respondents reported that patient satisfaction has increased with the involvement of anesthesia services. CONCLUSIONS: Anesthesia coverage for EP procedures has continued to increase with an increase in patient satisfaction. Anesthesiologists have had to adapt and provide designated block time to accommodate this increase and also, in some instances, form teams that go beyond simply cardiac anesthesiologists to care for these patients during their procedures.