Growing use of complex therapies for heart rhythm abnormalities

 

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The EHRA (European Heart Rhythm Association) White Book 2014 will be officially launched at the CARDIOSTIM EHRA EUROPACE 2014 congress which starts today in Nice, France.

The White Book reports on the current status of arrhythmia treatment in 49 of the 56 European Society of Cardiology (ESC) member countries for the year 2013. The new White Book is published in electronic format only and will be distributed on a USB stick as well as being available on the EHRA website. As a new feature, the USB stick contains complete data also from the six previous editions of the White Book.

EHRA White Book co-coordinator Dr David O. Arnar (Iceland) said:

"The EHRA White Book has become an important annual reference of the status of treatment of arrhythmias as well as to assess the availability of therapies for heart rhythm abnormalities in the ESC countries. The data collection is the result of voluntary participation by the EP Working groups of the National Cardiac Societies and we are indebted to our collaborators that provided us with this valuable information."

The White Book contains data on the use of cardiovascular implantable electronic devices (CIEDs) including pacemakers, implantable cardiac defibrillators (ICDs), cardiac resynchronization therapy (CRT) devices, and lead extractions procedures in Europe.

According to Dr. Arnar lead extraction has become increasingly important as the number of individuals with transvenous CIED leads continues to expand. The leads are the most delicate part of the CIED system and in many cases they need to be replaced either due to damage, malfunction or infection, because of the limited capacity for leads in the venous system.

As in previous years the highest number of CIED implantations and ablations was in Germany (total procedures 163.040), Italy (90.602), United Kingdom (78.081), France (60.000) and Russia (58.825). However, the White Book data reveal a large range in the number of CIED implantations and ablations in the ESC member countries.

The countries with the lowest combined number of CIED implants and ablations were in San Marino (349), Armenia (278), Moldova (287), Montenegro (299) and Malta (329). There were some countries, such as Kazakhstan, that reported a surge in the number of CRT devices, ICDs and loop recorders. The use of loop recorders is on the rise, but this device is important for diagnostic purposes and allows physicians to follow the results of interventions such as ablations.

Italy had the biggest increase in the use of loop recorders over one year, from 2500 in 2012 to 3700 in 2013. Also interesting is the trend for use of CRT defibrillators instead of CRT pacemakers, which is illustrated by the data from Belgium.

EHRA White Book Coordinator Professor Pekka Raatikainen (Finland) said:

"White Book data confirm that implantable devices and catheter ablation have become key components in the treatment of tachy- and bradyarrhythmias. There is a continued increase in complex therapeutic interventions such as atrial fibrillation ablation and CRT implantation in most countries. On the other hand, a large disparity in the availability and use of these treatments still exists across Europe. This is of concern and therefore one of the major goals of EHRA is to reduce this gap."

Another important feature of the White Book is an assessment of obstacles to implementation of guidelines for arrhythmia care across Europe. The White Book presents data by country and compares it to the previous year´s statistics. Further analysis and graphic presentation of the White Book data with interpretations from experts in the field will be published in a dedicated supplement of EHRA's official journal EP Europace later this year.

"The presentation of the data in the supplement will allow us to readily compare activities between countries and show how utilization of treatment has changed over time," said Prof. Raatikainen. "It will thus serve as a benchmark and pinpoint the inequalities in access to specialized arrhythmia care in Europe."

"We hope to expand next year's data collection to include ventricular tachycardia ablations. This is the next frontier in ablation therapy. While many of these patients already have an ICD there is a growing need to provide treatment options which reduce the ventricular tachycardia burden in this population," Dr. Arnar added.