Abstract
The first and second waves of the coronavirus disease 2019 (COVID-19) pandemic has deeply influenced our thinking on medical resources and forced us to grade interventions according to necessity and priority. In cardiology this selection is difficult and risky in every individual case. The current recommendations on pacemaker and defibrillator treatment as well as aftercare are presented with the aim of supporting the individual medical decisions with comprehensible and reliable arguments and to be able to justify these to the patients. In individual countries these considerations have led to a clear reduction in the implantation of pacemakers and defibrillators and also of ablation in cases of supraventricular arrhythmia. The impacts of the pandemic can be comprehended from the activity profiles of rhythmological implants. The necessity and opportunities for telemedical surveillance have become abundantly clear during this period as has the insufficient use and lack of structure of this technology. The current positive assessment by the Federal Joint Committee (G-BA) for telemedical monitoring in cardiac insufficiency is a step in the right direction; however, the implementation and remuneration will lead to further discussions. A new algorithm, which is based on the recognition of heart sounds and is used in the first atrioventricular (AV) leadless cardiac pacemaker, is discussed. So far, the indications for a primarily prophylactic implantation of an implantable cardioverter defibrillator (ICD) have essentially been based on the left ventricular ejection fraction, especially in nonischemic cardiomyopathy. The necessity and importance of detection of intramural fibrosis and cicatrices in magnetic resonance imaging (MRI) are discussed and could support decision-making.