Electrophysiology in the time of coronavirus: coping with the great wave
Authors: Li Jia , Mazzone Patrizio , Leung Lisa WM , Lin Weiqian , D’Angelo Giuseppe , Ma Jun , Li Jin , Akhtar Zaki , Li Yuechun , Della Bella Paolo E. , Lin Jiafeng , Gallagher Mark M 
Published: March 2020

ABSTRACTAimsTo chart the effect of the COVID-19 pandemic on the activity of interventional electrophysiology services in affected regions.MethodsWe reviewed the electrophysiology laboratory records in 3 affected cities: Wenzhou in China, Milan in Italy and London, United Kingdom. We interviewed electrophysiologists in each centre to gather information on the impact of the pandemic on working patterns and on the health of staff members.ResultsThere was a striking decline in interventional electrophysiology activity in each of the centres. The decline occurred within a week of the recognition of widespread community transmission of the virus in each region and shows a striking correlation with the national figures for new diagnoses of COVID-19 in each case. During the period of restriction, work-flow dropped to <5% of normal, consisting of emergency cases only. In 2 of 3 centres, electrophysiologists were redeployed to perform emergency work outside electrophysiology. Among the centres studied, only Wenzhou has seen a recovery from the restrictions in activity. Following an intense nationwide program of public health interventions, local transmission of COVID-19 ceased to be detectable after February 18th allowing the electrophysiology service to resume with a strict testing regime for all patients.ConclusionInterventional electrophysiology is vulnerable to closure in times of great social difficulty including the COVID-19 pandemic. Intense public health intervention can permit suppression of local disease transmission allowing resumption of some normal activity.CONDENSED ABSTRACTCOVID-19 has affected every aspect of life worldwide. In the electrophysiology labs of Wenzhou, Milan and London, activity was suspended as the disease took hold. Only Wenzhou has resumed normal services, facilitated by a monumental nationwide program of public health interventions and supported by stringent testing protocols.WHAT’S NEWWe describe the impact of the COVID-19 pandemic on interventional electrophysiology units in 3 cities: Wenzhou, Milan and London.In all cases, the routine work of the electrophysiology was virtually suspended within a week of the recognition of widespread virus transmission in the area.During the period of restricted activity imposed by the pandemic, centres have dealt with a small number of emergency ablations only, a balanced mix of atrial, ventricular and junctional arrhythmias.In 2 of the 3 centres, electrophysiologists were redeployed to perform other medical duties including in COVID-19 wards.COVID-19 infection occurred in medical and nursaing staff in 2 of the 3 centres.Only in the cases of Wenzhou, China, has a resumption of normal activity been possible; this follows intensive public health intervention and is protected by stringent testing.FUNDINGNoneETHICAL APPROVALNone required from the Research Ethics Committee (REC) London according to the type of study. Institutional ethical approval obtained at the centres of: St. George’s Hospital NHS Foundation Trust, London, UK; Local Health Authority Ethical Approval was obtained in: The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University in Wenzhou, PR China and San Raffaele in Milan, Italy.CONSENTInformed consent was obtained from all participants/interviewees who took part in this study.