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EP Wire survey results and full text articles

Results and full articles from the surveys


 

Read the last press release  on Differences in attitude, education, and knowledge about oral anticoagulation therapy among patients with atrial fibrillation in Europe: result of a self-assessment patient survey conducted by the European Heart Rhythm Association.

Implantation of subcutaneous implantable cardioverter defibrillators in Europe: results of the European Heart Rhythm Association survey (AUGUST 2016)

The efficacy of implantable cardiac defibrillators (ICDs) for primary or secondary prevention of sudden cardiac death (SCD) has been well documented. Nevertheless, morbidity and complications of these devices have been of major concern. In particular, the presence of a transvenous lead has been perceived as the Achilles' heel of these systems. The recent release of an entirely subcutaneous implantable cardiac defibrillator (S-ICD) possibly represents a further step in the evolution of defibrillator technology. The S-ICD may indeed offer a viable therapeutic option in selected patients at high risk of SCD and in whom pacing is not required and there is growing clinical evidence regarding its safety and efficacy. However, current clinical practice of S-ICD use among European countries remains largely unknown. The aim of this European Heart Rhythm Association (EHRA) survey was to provide better insight into S-ICD utilization across a broad range of European centres.

The results are here and the publication is available here.

Non-vitamin K oral anticoagulants in patients with atrial fibrillation after cardiac surgery: the results of the European Heart Rhythm Association Survey (JUNE 2016)

Atrial fibrillation (AF) and atrial flutter occur in one-third of the patients after cardiac surgery, most often within the first few days post-operatively. This is associated with longer hospital stay and worse long-term prognosis.There is an increased risk of perioperative stroke, which can be potentially reduced by appropriate anticoagulation. However, anticoagulation in the post-operative period may also increase the risk of bleeding, particularly pericardial bleeding and cardiac tamponade.

The purpose of this European Heart Rhythm Association survey was to assess the current practice concerning the use of oral anticoagulation in patients with post-operative atrial fibrillation (pre-existing or new-onset). 

The results are here and the publication is available here.

Replacement of implantable cardioverter defibrillators and cardiac resynchronization therapy devices: results of the European Heart Rhythm Association survey (JUNE 2016)

Implantation of cardiac devices is the most common interventional procedure performed by cardiac electrophysiologists in Europe and worldwide. There is the sufficient knowledge on the clinical benefit of de novo implanted cardiac devices and international guidelines that deal with the indications for sudden cardiac death prevention, cardiac pacing, and cardiac resynchronization therapy (CRT). However, scientific and real-world data as well as practice guidelines on device replacement are sparse.

The purpose of this European Heart Rhythm Association (EHRA) EP Wire survey was to assess the management, indications, and techniques for implantable cardioverter defibrillator (ICD) and CRT device replacement in Europe.

The results are here and the publication is available here.

The role of the arrhythmia team, an integrated multidisciplinary approach to treatment of patients with cardiac arrhythmias (may 2016)

Management of patients with cardiac arrhythmias is increasingly complex because of continuous technological advance and multifaceted clinical conditions associated with ageing of the population, the presence of co-morbidities and the need for polypharmacy. The aim of this European Heart Rhythm Association Scientific Initiatives Committee survey was to provide an insight into the role of the Arrhythmia Team, an integrated, multidisciplinary approach to management of patients with cardiac arrhythmias. Forty-eight centres from 18 European countries replied to the Web-based questionnaire.

The results are here and the publication is available here.

The use of wearable cardioverter-defibrillators in Europe (February 2016)

Implantable cardioverter-defibrillators (ICDs) have proved effective in primary and secondary prevention of sudden cardiac death (SCD). However, a significant proportion of patients presents with contraindications to ICD or does not meet the criteria for ICD implantation, as defined by current guidelines. The wearable cardioverter-defibrillator (WCD) may be considered an attractive temporary alternative to ICD.
The aim of this European Heart Rhythm Association (EHRA) survey was to collect data on the use of wearable cardioverter-defibrillators (WCDs) among members of the EHRA electrophysiology research network.

The results are here and the publication is available here.

Management of atrial fibrillation in patients with chronic kidney disease in Europe (December 2015)

Chronic Kidney Disease (CKD), defined as a glomerular filtration rate (GFR) of <60 mL/min per 1.73 m2 for >3 months, is present in >10% of adults. There is a complex interplay between kidney and cardiovascular function, and even mild CKD is associated with increased cardiovascular morbidity and all-cause mortality.

The purpose of this European Heart Rhythm (EHRA) Scientific Initiatives Committee EP Wire Survey was to assess ‘real-world’ practice in the management of AF patients with CKD in the European electrophysiology (EP) centres.

The results are here and the publication is available here.

Review of 6 years of EP WIRES ACTIVITY (november 2015)

The purpose of this review was to summarize the results of past EP wires in terms of coverage of the main topics in EP and to evaluate the acceptance and the feedback from the responding physicians, in order to increase the participation in the surveys and to better address the research needs and aspirations of the European EP community.

The results are here and the publication is available here.

cURRENT ABLATION TECHNIQUES FOR PERSISTENT ATRIAL FIBRILLATION IN EUROPE (OCTober 2015)

Catheter ablation is now well established treatment option for atrial fibrillation (AF), with rising numbers of procedures conducted
worldwide.Patients with persistent AF represent a significant proportion of ablation candidates.

The aim of this survey was to provide insight into current practice regarding ablation of persistent atrial fibrillation (AF) among members of
the European Heart Rhythm Association electrophysiology research network.

This is EP Wire was conducted thanks to an unrestricted educational grant from Medtronic.

The results are here and the publication is available here.

Management of arrhythmias detected by implanted cardiac devices (September 2015)

The management of arrhythmias detected by devices is challenging, especially when they are asymptomatic. We are seeking to assess how Cardiologists manage symptomatic and asymptomatic arrhythmias detected by implanted cardiac devices.

The results are here and the Publication is available here.

Management of ventricular tachycardia – antiarrhythmic drugs, catheter ablation and implantable cardioverter defibrillator therapies (Aug. 2015)

This questionnaire aims at obtaining information on European-wide clinical practice in the management of ventricular tachycardia with emphasis on treatments use of antiarrhythmic drugs, implantable defibrillator and catheter ablation therapies.
Results | Full article

Routines for fluoroscopy use in ep-clinical practice in europe (Jul. 2015)

This survey evaluates and compares current and former routines for fluoroscopy use in EP and if there is any difference for physicians and patients.
Results | Full article

How are European patients at risk of malignant arrhythmias or sudden cardiac death identified and informed about their risk profile (June 2015)

The survey will include several questions about the strategy and the clinical tools for identification of best candidates to life-threatening therapy such as implantable cardioverter defibrillator (ICD). 

Results | Full article

Preference for oral anticoagulation therapy for patients with atrial fibrillation in Europe in different clinical situations (May 2015)

The purpose of this European Heart Rhythm Association (EHRA) survey is to assess the clinical practice in relation to the use of oral anticoagulation therapy for patients with atrial fibrillation (AF) in Europe, in different clinical situations.

Results | Full article

Left atrial appendage closure–indications techniques and outcomes (April 2015)

The purpose of this EP Wire is to investigate how these catheter-based methods for LAAO are being used in Europe regarding indications, techniques and outcomes.

Results | Full article

How are patients  with atrial fibrillation approached and informed about their risk profile and available therapies in Europe? (March 2015)

With this  EP Wire Survey, we aim to elicit common practices in approaching AF patients and informing them about their risk profiles and available therapies in the EP Network centres in Europe.

Results  | Full article

Clinical management of arrhythmias in elderly patients (Feb 2015)

The purpose of this survey was to assess clinical practice in management of cardiac arrhythmias in elderly patients (age ≥75 years) in the European countries. The data are based on an electronic questionnaire sent to the European Heart Rhythm Association Research Network members.  Responses were received from 50 centres in 20 countries. The results of the survey have shown that management of cardiac arrhythmias is generally in accordance with the guidelines and consensus recommendations on management of cardiac arrhythmias, although there are some areas of variation, especially on age limit and exclusion of elderly patients for anticoagulation, ablation, and device therapy.

Results | Full article

Do cardiologists follow the European guidelines for cardiac pacing and resynchronization therapy? (Jan 2015)

The purpose of this European Heart Rhythm Association (EHRA) EP wire surveywas to evaluate the implementation of the current guidelines for cardiac pacing and cardiac resynchronization therapy (CRT) in Europe. A total of 48 centres replied to the survey, 34 of them (71%) were university hospitals. All responding centres implement CRT in patients with classical indications.  The results of this survey showed a good adherence to some of the current recommendations. Still some reluctance exists when offering the device therapy to patients with QRS duration in the lower range.

Results | Full article

Management of malfunctioning and recalled pacemaker and defibrillator leads

The aim of this survey was to describe the different strategies regarding the management of malfunctioning and recalled pacemaker and defibrillator leads across Europe. A questionnaire has been designed to assess the current practice and physician’s approach to the management of leads which are faulty, unnecessary, and/or recalled. Responses to the questionnaire were received from 34 hospitals—members of the European Heart Rhythm Association (EHRA) electrophysiology (EP) research network. The survey involved both very high and low volume implanting centres, with 85% of the responding centres performing lead extraction. The survey provides a panoramic view of operator’s decision making in the field of malfunctioning, recalled, and redundant leads and outlines a common point of view on lead abandonment and factors influencing the decision about lead extraction. The main factors strongly influencing the decision making were patient’s age (59%), the presence of the
damaged leads (44%), and the lead dwelling time (44%). Regarding the lead abandonment, the main concern (61%) was the potential greater difficulty associated with lead extraction in the future. High volume extracting centres showed a greater propensity to removing the malfunctioning or recalled leads compared with low volume or non-extracting centres. This EP Wire survey gives a snapshot of the operators’ approaches and options regarding redundant, malfunctioning, and recalled lead management and may form the basis for future prospective research on this topic.

ResultsFull article

Management of Pediatric Arrhythmias

The vast majority of paediatric arrhytmias concerns childer older than 1 year and patients with grown-up with grown-up congenital heart disease. In 65% of the hospitals there is a specialized paediatric centre, and the most commonly observed arrhythmias include Wolff-Parkinson-White syndrome and atrioventricular nodal re-entry tachycardias (90.24%).

Results | Full article

Lone AF, work-up and management

Thirty-two European centres, all members of the EHRA EP research network, responded to this survey and completed the list of questions. The prevalence of lone atrial fibrillation (AF) is ≤ 10% in 19 centres (60%). Isolated left atrial enlargement and left ventricular dysfunction represents heart disease according to 50% and 84% of participating centres, respectively, and excludes the diagnosis of lone AF. 

Results | Full article

Arrhythmia detection. Common practice -  Use of ECG monitoring systems (24-72 hrs, ELR, ILR) for arrhythmias detection

The aim of this European Heart Rhythm Association (EHRA) survey was to assess the use of different monitoring techniques in the evaluation of patients with unexplained syncope, palpitations and in those with established diagnosis of atrial fibrillation.
Forty-five centres in Europe answered the questionnaire and the majority (78%) were university hospitals. Glance through the

Results | Full article

Standards for device implantation and follow-up: personnel, equipment and facilities

Cardiac device implantation is the most common of all invasive cardiac electrophysiological procedures. Over 250 000 devices are implanted each year in Europe.

The purpose of this European Heart Rhythm Association (EHRA) survey was to assess the facilities, personnel, and protocols of members of the EHRA electrophysiology (EP) research network involved in device implantation.  Cardiac device implantation as a day case is the planned admission for routine elective device implantation in 30% of hospitals, 47% of hospitals have a single night stay, and 23% of hospitals have admission durations of two or more nights. Device implantation is available as a 24 h service, 365 days a year in 38% of hospitals. The commonest other model was as a daytime service on weekdays in 45% of hospitals. Read the full article below and you can also have a look at the results from the survey :

Results   |   Full article

Personnel, equipment, and facilities for electrophysiological and catheter ablation procedures in Europe

Clinical electrophysiology (EP) and catheter ablation of arrhythmias are rapidly evolving in recent years. More than 50 000 catheter ablations are performed every year in Europe. Emerging indications, an increasing number of procedures, and an expected high quality require national and international standards as well as trained specialists. The purpose of this European Heart Rhythm Association (EHRA) survey was to assess the practice of requirements for EP personnel, equipment, and facilities in Europe. 

The survey reflects the current EP personnel situation characterized by a high training requirement and specialization. Arrhythmia sections are still most often part of cardiology departments and the head of cardiology is seldom a heart rhythm specialist. Currently, the vast majority of EP physicians are men, although in the subgroup of physicians younger than 40 years, the proportion of women is increasing. Read the full article below.

Results |   Full article

Current implantable cardioverter-defibrillator programming in Europe

The purpose of this European Heart Rhythm Association (EHRA) survey was to examine the current practice on the choice of implantable cardioverter-defibrillator (ICD) type, use of defibrillation testing, and ICD programming for detection and therapy of ventricular arrhythmias. In accordance with recent guidelines and the results of observational studies, the majority of EHRA research network centres reported a high utilization rate of dual-chamber ICDs in the presence of symptomatic and asymptomatic sinus node dysfunction, biventricular ICD in highdegree atrioventricular block and QRS duration ,120 ms, and a limited use of defibrillation testing either in primary and secondary prevention settings. Activation of the long ventricular tachycardia (VT) detection window, slowVTzone, antitachycardia pacing before shock for slowand fast VT, and atrial tachyarrhythmia discrimination were considered useful in ICD programming for the majority of patients.The full published article is available below...

Results |   Full article

Stroke and bleeding risk evaluation in Atrial Fibrillation: Results of the European Heart Rhythm Association survey

The aim of this European Heart Rhythm Association (EHRA) survey was to assess clinical practice in relation to stroke and bleeding risk evaluation in atrial fibrillation, particularly regarding the use of risk evaluation schemes, among members of the EHRA electrophysiology (EP) research network. In this EP Wire survey, we have provided some insights into current practice in Europe for the use of these risk assessment schemes. There were some obvious practice differences. However, reassuring information on current practice in Europe was evident, but more focus on renal function is warranted, especially facing the fact that novel oral anticoagulants are used for antithrombotic therapy.

Results |  Full article

Diagnosis and management of patients with inherited primary arrhythmia syndromes- European Clinical Practice

Inherited arrhythmia disorders associated with structurally normal heart (i.e. long and shortQTsyndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, early repolarization syndrome, idiopathic ventricular fibrillation) cause 10% of 1.1 million sudden deaths in Europe and the USA. The purpose of this European Heart Rhythm Association (EHRA) electrophysiology wire survey was to assess the European clinical practice adopted for the diagnosis and management of these disorders. The survey was based on an electronic questionnaire sent out to the EHRA Research Network centres. Responses were received from 50 centres in 23 countries. The results of the survey show that inherited arrhythmia syndromes have a relatively low burden and are diagnosed and managed in accordance with the current guidelines. However, more than 50% of centres do not participate in any existing registry underlining the need for establishing a pan-European registry of these disorders.

Results |  Full article

Periprocedural management of Atrial Fibrillation Ablation

The purpose of this EP Wire survey was to assess clinical practice in periprocedural management of atrial fibrillation ablation. This survey is based on an electronic questionnaire sent to the European Heart Rhythm Association Research Network members. Responses were received from 78 centres in 20 countries. The results of the survey have shown that periprocedural management is generally in accordance with guidelines and consensus recommendations on ablation for atrial fibrillation ablation, although there are some areas of variation. Differences between high and low-volume centres are observed with respect to patient selection, antiarrhythmic drug management, and heparin bridging.

Results |  Full article

European management strategy for AF patients presenting with acute coronary syndrome.

Given a lack of the precise guidelines for treatment of patients with AF and ACS, the aim of this survey is to provide an insight into current practice in Europe regarding treatment of patients with non-valvular AF presenting with an ACS.          

Results |  Full article

Remote Monitoring on Cardiac Implantable Electronic Devices in Europe

The aim of this survey was to provide insight into current practice regarding the use of remote monitoring for cardiac devices in Europe. 

Results Full article

Current investigation and management of patients with syncope

The aim of this European Heart Rhythm Association (EHRA) survey was to provide an insight into the current practice of work-up and management of patients with syncope among members of the EHRA electrophysiology research network.

Results | Full article

Preference of various techniques-tools for device implantation

The aim of our survey is to explore procedural practice in terms of tools and techniques used for CIED ( Cardiac Implantable Electronic Devices) implantation in European countries.

Results | Full article

Practice of use of NOAC therapies in Europe.

The purpose of this EP Wire survey is to have a picture of daily practice regarding the everyday use of NOACs in Europe

Results | Full article

Imaging techniques in electrophysiology and implantable device procedures

The purpose of this European Heart Rhythm Association (EHRA) survey is to assess the implementation and use of imaging techniques in cardiac electrophysiology (EP) and device procedures across European cardiovascular centres.

Results | Full article

X-ray exposure for implanting and ablating physicians

The aim of this survey is to evaluate physician’s and authorities policies and clinical practices when using occupational X-ray during ablation procedures and device implantation.

Results | Full article  

Prophylactic antiarrhythmic drugs for atrial fibrillation (AF)

The aim of this survey was to provide insight into current use of prophylactic antiarrhythmic drugs for atrial fibrillation (AF) in the European Countries. 

ResultsFull article

Management pre-excitation syndromes

The aims of this survey was to provide insight into treatment activity, the strategy of treatment and risk stratification of patients with asymptomatic and symptomatic ventricular preexitation across Europe.

Results | Full article

Use of atrial appendage occluder for stroke prevention

The use of left atrial appendage occlusion to reduce the risk of stroke in atrial fibrillation has recently gained much attention.  The aim of this EP wire survey is to know the practice of European Centres regarding use, peri-procedural management and outcomes of left atrial appendage occlusion devices.

Results  | Full article

Management of patients with sustained ventricular tachycardia

Ventricular tachycardia (VT) is a complex arrhythmic syndrome including different etiologies. This EP WIRE provided us a picture about diagnostic and therapeutic management of patients with sustained VT of the different experience in several European countries .

Results | Full article 

Current practice on Transvenous Lead extractions

Lead Extraction is a rapidly expanding field that is increasing with the number of devices and leads implanted and which is also partially unexplored across European countries concerning appropriate indications, techniques, success rates, safety and follow-up. A Lead Extraction Registry is about to be launched and should start by the autumn. The aims of this Lead Extraction Registry are to improve healthcare standards and education by generating data from a high number of representative centers across Europe.

Results |  Full article

Periprocedural Anticoagulation Therapy

This EP Wire surveyed clinical practice with regard to the use of antithrombotic therapy in relation to device implantation (pacemakers, ICT,resynchronization therapy) and atrial fibrillation ablation in 71 centres—members of the European Heart Rhythm Association research network.  The results of this survey show variation in clinical practice, but reassuringly some consistency with guidelines and consensus recommendations on the management of periprocedure (devices, ablation) antithrombotic therapy.

Results | Full article

Surgical and Hybrid AF Ablation procedures

Surgical techniques for curative ablation of atrial fibrillation, have evolved from the original Cox Maze-III procedure to minimally invasive stand alone procedures with new energy sources and eletrophysiological validation of the lesion set which requires close collaboration between cardiologists ans cardiac surgeons.

Results | Full article 

Management of Survival of Out of Hospital Cardiac Arrest

Out of Hospital Cardiac Arrest (OHCA) is a leading cause of death among adults in the European countries. Survival rates vary widely across the European countries. The results of this EP WIRE enabled EHRA to compare interventions modalities, local organizations, outcomes and identifies opportunities to improve quality of care and ascertain whether resuscitation and following cure are provided according to evidence-based guidelines.
Definitions: An OHCA is defined as cessation of cardiac mechanical activity that is confirmed by the absence of signs of circulation and that occurs outside of a hospital setting.
The majority of such events have a cardiac etiology.

Results | Full article

Cardiac Resynchronisation Therapy

(AF, RBBB, Guidelines, Nonrespond)

Cardiac resynchronisation therapy (CRT) has become a readily available option for patients with moderate/severe heart failure. However, there are still several open issues.  The results of recent trials show that beneficial effects of CRT in patients with mild heart failure (HF) are very similar to those observed in cohorts of patients with severe HF. To date, patients with atrial fibrillation have not been adequately studied in large trials.  Practice regarding the choice of the CRT device varies widely between countries.
 

Atrial Fibrillation Ablation Techniques and strategies

This survey was designed for persons who perform AF ablation in their cath labs. We collected 50 answers to this survey.

Results | Full article

Device Infections

Infections related to Cardiac Implantable Electronic Devices are growing in the last decade. The aim of this EP wire survey is to know the practice of European Centres regarding diagnosis, treatment and prophylactic treatment of CIED infections.

Results | Full article 

MRI in device patients

A significant part of patients with cardiac implantable electronic devices (CIEDs) may develop a need to perform magnetic resonance imaging (MRI) study.  The number of MRI-compliant devices is still low, and the data on performing MRI in older (non-MRI-compliant) devices is scarce.
The purpose of this survey is to get information about practices of dealing with the patients with implanted CIEDs and MRI procedures in European centres.

ResultsFull article

Validation of success following Atrial Fibrillation (AF) ablation

Catheter ablation of AF has become an important treatment modality in recurrent symptomatic AF when antiarrhythmic drug therapy has been ineffective or associated with unacceptable side effects. However, catheter ablation of Atrial Fibrillation is not a standardized procedure and indication and treatment strategies differ greatly between hospitals. Furthermore, there is neither a clear definition of what constitutes a successful ablation procedure nor agreement on validation approaches to the various currently used definitions of success. Thus clinical practice of AF ablation varies greatly as does follow-up (FU) strategy.

Results | Full article 

Attitude towards redundant leads and the practice of lead extractions

This survey has compared attitudes towards (endocardial) lead extraction, among European electrophysiology centres, with special attention paid to ‘redundant leads’. The main findings of this survey are:

  • Most of the centres performing lead extractions do so in low volume even though the number of implants may be high.
  • Approaches to the practice of lead extraction are based largely on clinical experience and individual sentiment but not on a rigorous evidence based.
  • Traction alone or in combination with extraction tools (but not laser) are commonly used for extraction.
  • The perception of need for involvement of cardio-thoracic surgeon varies.

Results | Full article 

Screening for, and management of, possible arrhythmogenic syndromes (channelopathies/ion channel diseases)

This survey assesses the current management strategies for individuals with electrocardiographic features, suggesting an arrhythmogenic syndrome [including long QT syndrome (LQTS), Brugada syndrome (BS), catecholaminergic polymorphic ventricular tachycardia (CPVT) or short QT syndrome] or family members of patients with a known arrhythmogenic syndrome, in 44 large European centres.

The principal findings of this survey were:

  • the number of new patients with arrhythmogenic syndromes (symptomatic and asymptomatic) is relatively small;
  • the clinical work-up of these patients consists mainly of non-invasive tests;
  • a relatively high use of genetic testing is noted, especially in LQTS and CPVT;
  • EP testing is commonly performed in asymptomatic BS patients and in family members of symptomatic BS patients; and
  • the majority of European electrophysiologists focus on first-degree relatives when dealing with family members of an index patient.

Results  |  Full article