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