Urgent or elective ablation of AF
Catheter ablation for AF patients with active infection is generally
contraindicated, which is similarly applied to COVID-19
patients.56Medical treatment to control ventricular
rate or rhythm with adequate anticoagulation based on the risk score
will be the preferred managment.56Electrical or
chemical cardioversion is a reasonable alternative for refractory
arrhythmias. COVID-19 fears put interventional laboratories on lockdown.
The asymptomatic carriers or mildly symptomatic COVID-19 patients remain
highly contagious and could be unexpectedly admitted. During active
pandemic, the hospitalization of these patient would significantly
increase the risk for group infection within hospitals. As most AF
ablation is not an urgent procedure, these procedures are suggested to
be postponed for several weeks or months during active pandemic to avoid
unexpected outbreak in hospitals.57However, some
electrophysiology (EP) procedures which are considered urgent or
emergent for the diseases with substantially risk of clinical
decompensation, hospitalization, or death might not be avoidable. These
include AF, atrial flutter, or atrioventricular nodal ablation which is
hemodynamically significant, severely symptomatic, drug and/or
cardioversion refractory, or preexcited AF with syncope or cardiac
arrest.57