Discussion and Conclusion
In summary, our examination of the FDA MAUDE database revealed
significant decreases in reported rates of malfunctions associated with
cardiac ablation percutaneous catheters, malfunctions associated with
cardiac ablation percutaneous catheters for treatment of atrial
fibrillation, and injuries associated with cardiac ablation percutaneous
catheters for treatment of atrial flutter during the pandemic. There
are several potential explanations for the observed decreases. One
explanation is that fewer cardiac ablations were performed during the
pandemic due to underdiagnosis and undertreatment, leading to fewer
adverse events. A German study of 74 hospitals demonstrated a decline in
hospital admissions for atrial flutter and atrial fibrillation during
the early phase of the pandemic, with daily admissions declining from
77.5 admissions/day to 44.4 admissions/day.5 The
decline was even more evident for patients with no prior history of
atrial flutter or atrial fibrillation; the daily admissions for this
subset of patients declined from 41.1 admissions/day to 21.9
admissions/day.5 The decrease in admission rates may
have been accompanied by underdiagnosis of cardiac diseases causing only
moderate to mild symptoms; a Danish nationwide registry reported a 47%
lower incidence of patients with new-onset atrial fibrillation or atrial
flutter during the pandemic in comparison to the prior
year.6 In a Polish study of a region inhabited by 4.6
million people, the number of patients hospitalized with atrial
fibrillation or atrial flutter declined 60% during the nationwide
pandemic lockdown in 2020, compared with the same period in the prior
year.7 In the same Polish population, the number of
percutaneous ablation procedures declined 69% during the nationwide
pandemic lockdown in 2020, compared with the same period in the prior
year.8 In an Italian survey of 104 physicians in 84
centers, 77.4% of centers reported a significant reduction in elective
ablations during the pandemic.9 In Spain, the Spanish
Catheter Ablation Registry reported an 18% decline in ablations
procedures during the pandemic year 2020 versus the prior year
2019.10 In a study of the Health Episodes Statistics
database of England, covering all 147 National Health Service (NHS)
hospitals in England, the number of ablations for atrial fibrillation
declined 83%, and all other ablations declined 64%, during three weeks
of lockdown during the pandemic compared to the previous
year.11 Given the cardiovascular complications of
COVID-19, it might be expected that hospital admissions for atrial
flutter or atrial fibrillation would increase, yet the opposite has been
observed. Further investigation is needed to determine the extent of
cardiovascular underdiagnosis and undertreatment during the COVID-19
pandemic