Impact of COVID-19 Pandemic on the Volume, Cost, and Outcomes of Cardiac Electrophysiology Procedures in the United States.

BACKGROUND: During the COVID-19 pandemic, professional societies recommended deferral of elective procedures for optimal resource utilization.

OBJECTIVE: We sought to assess changes in procedural trends and outcomes of electrophysiology (EP) procedures during the pandemic.

METHODS: National Inpatient Sample databases was used to identify all EP procedures performed in the US (2016-2020) using ICD-10 codes. We evaluated trends in utilization, cost/revenue, and outcomes from EP procedures performed.

RESULTS: An estimated 1.35 million EP procedures (82% devices and 18% catheter ablation) were performed (2016-2020) with significant yearly uptrend. During the pandemic, there was a substantial decline in EP procedures utilization from 5-year peak of 298 cases/million population in second quarter (Q2) of 2019 to a nadir of 220 cases in Q2 of 2020. In 2020, the pandemic was associated with the loss of 50,233 projected EP procedures (39,337 devices and 10,896 ablations) with subsequent revenue loss of 7.06 billion dollars. This deficit was driven by revenue deficit from DC-PPM (2.88 billion, 49.3% of lost cases), ablation procedures (1.84 billion, 21.7% of lost cases), and ICD (1.36 billion, 12.0% of lost cases). To the contrary, there was 9.4% increase in the utilization of leadless PPM. EP device implantation during the pandemic was associated with higher adverse in-hospital events (9.4% vs. 8.0%, p<0.001).

CONCLUSION: In the US, the significant decline in EP procedures during the pandemic was primarily driven by the reduction in DC-PPM utilization, followed by arrhythmia ablation and ICD implantation. There was a substantial increase in leadless PPM utilization during the pandemic.