General practice after COVID-19 pandemic
Excessive delays could threaten patient prognosis even for catheter ablations on the regular basis to palliate drug-refractory arrhythmias. Therefore, the re-initiation of regular procedure with adequate protection and infection control is recommended after thepandemic is under control. The setup of hospital-based infection control protocols for ablation procedures will be critical to avoid outbreak in the hospital.61The procedure and preparation for AF ablation are still mostly complied with current guideline.56However, several recommendations are made for the preventing viral transmission as adequacy. There is no consensus whether universal screening should be applied for all the patients before interventional procedures. However, the test for COVID-19 should be performed, provided that recent travel history, contact history, fever after high-risk exposures, or typical symptoms are highly suggesting COVID-19 infection. All the admitted patients and their companions should declare their health condition, travel, and contact history. On-site visitors are not avoided, and the stay in the hospital for patients and visitors should be minimized to decrease the risk of nosocomial infection. Instead, virtual video visit through cell phone or webcam is suggested. A dictated catheter laboratory with independent air-supply and ventilation, or negative pressure should be reserved for suspicious COVID-19 cases.57 Split operation is strictly implemented in our country. All staff is divided into 2-3 independent working shifts without personal contact during the daily activities. High flow oxygen, intubation, noninvasive positive pressure ventilation, or transesophageal echocardiography are generally not recommended as these increase the chance of virus spreading and transmission to the operators. In addition to personal protective equipment of medical personnel, patients should also wear face masks during hospital stay and procedures. CT scanning or intracardiac echocardiography could be considered to exclude atrial thrombus rather than transesophageal echocardiography before AF ablation procedure. Either the procedure time or hospital stay should be minimized.57