Interventional cardiology

Congenital heart disease added to Society’s COVID-19 advice

The CSANZ’s Heart Rhythm Council COVID-19 Pandemic working group has updated their position statement to include recommendations around electrophysiology and CIEDs for children and adults with congenital heart disease.

The statement reiterated that children in general have less severe COVID-19 disease than adults and present less frequently to hospital.

“The biggest burden of this pandemic will be on the adult population, but we have many shared resources, and interdisciplinary collaboration in this instance may largely be for the paediatric services to make space for the huge onslaught of very sick adult patients.”

However they also noted the specialised medical and surgical teams who manage congenital heart disease will be required to provide ongoing paediatric cardiac care.

Some specific recommendations during the COVID-19 pandemic included:

Indications for EP/ablation in children
1. Cardiac arrest in association with pre-excited AF;
2. Arrhythmia causing need for ECMO and unresponsive to medical management;
3. Incessant arrhythmia with severe ventricular dysfunction and failed medical management (where the balance of risks favours ablation rather than protracted inpatient medical management (e.g. tachymyopathy due to EAT, PJRT or VT).

Indications for EPS/ablation in adult CHD patients
Similar to the general adult population with the possible addition of:
1. Cardiac arrest secondary to atrial flutter in RV dependent circulation;
2. VT Storm, particularly in Tetralogy/Rastelli subgroup.

Indications for pacing/defibrillation
1. Congenital complete heart block– newborn with heart rate less than 55bpm, or at all ages with syncope;
2. Syncope due to slow heart rate /intermittent AV block;
3. Postoperative complete heart block;
4. Pacemaker dependent and pacemaker at EOL;
5. Secondary prevention defibrillator implant;
6. Replacement of defibrillator device at EOL for high risk patients.
7. Removal of infected devices
8. Insertion of loop recorder in known channelopathy/cardiomyopathy only.

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